Healthcare Provider Details

I. General information

NPI: 1467216044
Provider Name (Legal Business Name): FLORANNE CRUZ. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SAVANNAH AVE
STATESBORO GA
30458-4801
US

IV. Provider business mailing address

116 SAVANNAH AVE
STATESBORO GA
30458-4801
US

V. Phone/Fax

Practice location:
  • Phone: 912-243-9200
  • Fax: 912-243-9207
Mailing address:
  • Phone: 912-243-9200
  • Fax: 912-243-9207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DYSHAN L SMITH
Title or Position: GENERAL MANAGER
Credential:
Phone: 912-243-9200