Healthcare Provider Details

I. General information

NPI: 1114874914
Provider Name (Legal Business Name): INNOVIA GA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 ARBOR CREEK WAY
ROSWELL GA
30076-1291
US

IV. Provider business mailing address

235 ARBOR CREEK WAY
ROSWELL GA
30076-1291
US

V. Phone/Fax

Practice location:
  • Phone: 770-309-9630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: LUCAS CATTON
Title or Position: CEO
Credential:
Phone: 770-309-9630