Healthcare Provider Details

I. General information

NPI: 1073296554
Provider Name (Legal Business Name): SPECTRIX METAPHYSICAL INSTITUTE, LTD. CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SUMMERWOOD DR
CLARKSTON GA
30021-3097
US

IV. Provider business mailing address

650 PONCE DE LEON AVE NE STE 300
ATLANTA GA
30308-1864
US

V. Phone/Fax

Practice location:
  • Phone: 404-465-2718
  • Fax:
Mailing address:
  • Phone: 404-465-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLTON JOHNSON
Title or Position: DIRECTOR OF METAPHYSICAL SERVICES
Credential: PHD, RMT
Phone: 404-465-2718