Healthcare Provider Details

I. General information

NPI: 1558500231
Provider Name (Legal Business Name): THERABEAT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 PAPER TRAIL WAY SUITE 302
CANTON GA
30115-5203
US

IV. Provider business mailing address

9880 HICKORY FLAT HWY
WOODSTOCK GA
30188-3081
US

V. Phone/Fax

Practice location:
  • Phone: 770-345-2804
  • Fax: 678-827-0927
Mailing address:
  • Phone: 770-687-2542
  • Fax: 770-783-5049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number07335
License Number StateGA

VIII. Authorized Official

Name: MRS. JENNIFER WALKER PUCKETT
Title or Position: MUSIC THERAPIST/DIRECTOR
Credential: MT-BC, NMT
Phone: 770-687-2542