Healthcare Provider Details

I. General information

NPI: 1457936825
Provider Name (Legal Business Name): DOPE HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 BLACKMON DR STE 440-12
DECATUR GA
30033-6196
US

IV. Provider business mailing address

176 SNOW BIRD DR
HAMPTON GA
30228-3528
US

V. Phone/Fax

Practice location:
  • Phone: 404-786-9253
  • Fax:
Mailing address:
  • Phone: 404-786-9253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAKEISHA BROWN
Title or Position: CEO
Credential: RN
Phone: 404-786-9253