Healthcare Provider Details

I. General information

NPI: 1164879136
Provider Name (Legal Business Name): HEALTHCOACHDC II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 TOWNE LAKE PARKWAY
WOODSTOCK GA
30189
US

IV. Provider business mailing address

2453 TOWNE LAKE PARKWAY
WOODSTOCK GA
30189
US

V. Phone/Fax

Practice location:
  • Phone: 770-592-2505
  • Fax: 770-592-2433
Mailing address:
  • Phone: 770-592-2505
  • Fax: 770-592-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7077
License Number StateGA

VIII. Authorized Official

Name: DR. PERI FLETCHER
Title or Position: OWNER/ DOCTOR
Credential: DC
Phone: 770-592-2505