Healthcare Provider Details

I. General information

NPI: 1831836980
Provider Name (Legal Business Name): HIGHER DESIRES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 LEHIGH BLVD
DECATUR GA
30034-6055
US

IV. Provider business mailing address

4236 LEHIGH BLVD
DECATUR GA
30034-6055
US

V. Phone/Fax

Practice location:
  • Phone: 678-386-7183
  • Fax:
Mailing address:
  • Phone: 678-386-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MS. MONICA WOOD
Title or Position: CEO
Credential:
Phone: 678-386-7183