Healthcare Provider Details

I. General information

NPI: 1477922748
Provider Name (Legal Business Name): PURE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 CRESTWOOD PKWY NW SUITE 290
DULUTH GA
30096-1805
US

IV. Provider business mailing address

3675 CRESTWOOD PKWY NW SUITE290
DULUTH GA
30096-1805
US

V. Phone/Fax

Practice location:
  • Phone: 770-212-9297
  • Fax:
Mailing address:
  • Phone: 770-212-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW WORTHY
Title or Position: PRESIDENT
Credential:
Phone: 770-212-9297