Healthcare Provider Details

I. General information

NPI: 1669660486
Provider Name (Legal Business Name): FIBROMYALGIA AND FATIGUE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 PALLADIAN VILLAGE DR SUITE 300
MARIETTA GA
30066-8200
US

IV. Provider business mailing address

16415 ADDISON RD SUITE 600
ADDISON TX
75001-3218
US

V. Phone/Fax

Practice location:
  • Phone: 678-494-7800
  • Fax: 678-494-7990
Mailing address:
  • Phone: 972-788-4001
  • Fax: 972-788-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MS. SUE HRIM
Title or Position: CHIEF CLINICAL OFFICER
Credential: R.N.
Phone: 972-788-4001