Healthcare Provider Details

I. General information

NPI: 1457093197
Provider Name (Legal Business Name): ANH VO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11090 SERENBE LN STE 350
PALMETTO GA
30268-2475
US

IV. Provider business mailing address

11090 SERENBE LN, PALMETTO, GA 30268 SUITE #350
PALMETTO GA
30268
US

V. Phone/Fax

Practice location:
  • Phone: 470-977-0722
  • Fax:
Mailing address:
  • Phone: 470-977-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: