Healthcare Provider Details

I. General information

NPI: 1477876589
Provider Name (Legal Business Name): ABSOLUTE SPINE AND HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SATELLITE BLVD NW STE D
SUWANEE GA
30024-7149
US

IV. Provider business mailing address

850 DOGWOOD RD STE C500
LAWRENCEVILLE GA
30044-7222
US

V. Phone/Fax

Practice location:
  • Phone: 770-614-7242
  • Fax: 770-614-7243
Mailing address:
  • Phone: 770-614-7242
  • Fax: 770-614-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007974
License Number StateGA

VIII. Authorized Official

Name: MS. DENNITRA WEEDEN
Title or Position: OWNER/ CHIROPRACTOR
Credential: D.C.
Phone: 678-437-3111