Healthcare Provider Details

I. General information

NPI: 1992431969
Provider Name (Legal Business Name): LYMPHWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 VICTOR DR
BUFORD GA
30518-2563
US

IV. Provider business mailing address

145 VICTOR DR
BUFORD GA
30518-2563
US

V. Phone/Fax

Practice location:
  • Phone: 770-310-8100
  • Fax: 833-760-2107
Mailing address:
  • Phone: 770-310-8100
  • Fax: 833-760-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA CANNON MARTIN
Title or Position: OWNER
Credential: MSOT/L, CLT, CLWT
Phone: 770-310-8100