Healthcare Provider Details

I. General information

NPI: 1750804969
Provider Name (Legal Business Name): HEALTH AUTHORITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2293 CANDLER RD
DECATUR GA
30032-6403
US

IV. Provider business mailing address

2293 CANDLER RD
DECATUR GA
30032-6403
US

V. Phone/Fax

Practice location:
  • Phone: 404-284-1255
  • Fax: 404-284-0125
Mailing address:
  • Phone: 404-284-1255
  • Fax: 404-284-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1938
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number101149
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38742
License Number StateGA

VIII. Authorized Official

Name: SONIA BROWN
Title or Position: DIRECTOR
Credential:
Phone: 404-284-1255