Healthcare Provider Details

I. General information

NPI: 1982352928
Provider Name (Legal Business Name): KAIZEN STRATEGIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3072 EVANS MILL RD
LITHONIA GA
30038-2418
US

IV. Provider business mailing address

3072 EVANS MILL RD
LITHONIA GA
30038-2418
US

V. Phone/Fax

Practice location:
  • Phone: 770-401-8114
  • Fax:
Mailing address:
  • Phone: 770-401-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KOLBY TERRELONGE
Title or Position: CEO
Credential:
Phone: 770-401-8114