Healthcare Provider Details

I. General information

NPI: 1821128174
Provider Name (Legal Business Name): HEALTHSPROUT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TOWNE LAKE PKWY
WOODSTOCK GA
30188-4843
US

IV. Provider business mailing address

180 TOWNE LAKE PKWY
WOODSTOCK GA
30188-4843
US

V. Phone/Fax

Practice location:
  • Phone: 770-517-2240
  • Fax: 770-587-2286
Mailing address:
  • Phone: 770-517-2240
  • Fax: 770-587-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC J RICHARDS
Title or Position: CEO,PRESIDENT
Credential: D.C.
Phone: 770-517-2240