Healthcare Provider Details

I. General information

NPI: 1104508522
Provider Name (Legal Business Name): 53 ACUPUNCTURE AND MASSAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2296 HENRY CLOWER BLVD, NEW LONDON PLAZA SUITE B
SNELLVILLE GA
30078
US

IV. Provider business mailing address

2296 HENRY CLOWER BLVD, NEW LONDON PLAZA SUITE B
SNELLVILLE GA
30078
US

V. Phone/Fax

Practice location:
  • Phone: 770-736-3121
  • Fax:
Mailing address:
  • Phone: 770-736-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HONG JESSICA CHEN
Title or Position: OWNER/HEALTH CARE PROVIDER
Credential: L.A.C, ACUPUNCTURIST
Phone: 678-549-0005