Healthcare Provider Details

I. General information

NPI: 1215330261
Provider Name (Legal Business Name): SUMMIT HEALTH CLINIC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 FRANKLIN RD SE SUITE C
MARIETTA GA
30067-8060
US

IV. Provider business mailing address

1033 FRANKLIN RD SE SUITE C
MARIETTA GA
30067-8060
US

V. Phone/Fax

Practice location:
  • Phone: 770-951-0080
  • Fax: 770-980-1500
Mailing address:
  • Phone: 770-951-0080
  • Fax: 770-980-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MEIRAV ERTLE
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 770-951-0080