Healthcare Provider Details

I. General information

NPI: 1811221377
Provider Name (Legal Business Name): AQUA-TOTS SWIM SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 VICTORIA NORTH CT
WOODSTOCK GA
30189-5439
US

IV. Provider business mailing address

103 VICTORIA NORTH CT
WOODSTOCK GA
30189-5439
US

V. Phone/Fax

Practice location:
  • Phone: 678-445-7323
  • Fax: 678-331-8024
Mailing address:
  • Phone: 678-445-7323
  • Fax: 678-331-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number30280
License Number StateGA

VIII. Authorized Official

Name: MRS. MINDY ANN BARAHONA
Title or Position: MANAGER
Credential:
Phone: 678-445-7323