Healthcare Provider Details

I. General information

NPI: 1477470763
Provider Name (Legal Business Name): INNATE ABUNDANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 SIXES RD STE 110
CANTON GA
30114-9120
US

IV. Provider business mailing address

142 LULA PAYNE TRL
BALL GROUND GA
30107-5032
US

V. Phone/Fax

Practice location:
  • Phone: 770-309-5605
  • Fax:
Mailing address:
  • Phone: 770-309-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DAWN MARIE MAVROMATIDIS
Title or Position: OWNER
Credential: DC
Phone: 770-309-5605