Healthcare Provider Details

I. General information

NPI: 1215273446
Provider Name (Legal Business Name): JUSTFIT BODY MAINTENANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2012
Last Update Date: 12/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 MESA DR SE
ATLANTA GA
30316-4915
US

IV. Provider business mailing address

2037 MESA DR SE
ATLANTA GA
30316-4915
US

V. Phone/Fax

Practice location:
  • Phone: 404-713-9382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN SPEARS
Title or Position: CEO/REHAB PRACTITIONER
Credential:
Phone: 404-713-9382