Healthcare Provider Details

I. General information

NPI: 1306766845
Provider Name (Legal Business Name): SACRED STORM ARTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MAGNOLIA ST
FORT VALLEY GA
31030-3946
US

IV. Provider business mailing address

308 MAGNOLIA ST
FORT VALLEY GA
31030-3946
US

V. Phone/Fax

Practice location:
  • Phone: 404-654-0415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: STORM M SAVAGE
Title or Position: DOULA
Credential:
Phone: 404-654-0415