Healthcare Provider Details

I. General information

NPI: 1477097012
Provider Name (Legal Business Name): HOPE SPRINGS WELLNESS AND RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENNESAW AVE NW SUITE 120
MARIETTA GA
30060-1051
US

IV. Provider business mailing address

800 KENNESAW AVE NW SUITE 120
MARIETTA GA
30060-1051
US

V. Phone/Fax

Practice location:
  • Phone: 678-213-7645
  • Fax: 678-723-1560
Mailing address:
  • Phone: 678-213-7645
  • Fax: 678-723-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number061186
License Number StateGA

VIII. Authorized Official

Name: DR. BRIAN P WHITE
Title or Position: OWNER
Credential: MD
Phone: 678-213-7645