Healthcare Provider Details

I. General information

NPI: 1669265252
Provider Name (Legal Business Name): SUWANEE HOLISTIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SMITHTOWN RD
SUWANEE GA
30024-6559
US

IV. Provider business mailing address

4000 SMITHTOWN RD
SUWANEE GA
30024-6559
US

V. Phone/Fax

Practice location:
  • Phone: 770-695-7606
  • Fax:
Mailing address:
  • Phone: 770-695-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JENNIFER WEN
Title or Position: OWNER
Credential:
Phone: 678-707-0105