Healthcare Provider Details

I. General information

NPI: 1851909857
Provider Name (Legal Business Name): 100 PERCENT NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8425 WALDRIP RD
GAINESVILLE GA
30506-5774
US

IV. Provider business mailing address

8425 WALDRIP RD
GAINESVILLE GA
30506-5774
US

V. Phone/Fax

Practice location:
  • Phone: 678-815-4551
  • Fax:
Mailing address:
  • Phone: 678-815-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATIE POTTS-CARR
Title or Position: OWNER
Credential: RD
Phone: 678-815-4551