Healthcare Provider Details

I. General information

NPI: 1336909324
Provider Name (Legal Business Name): EUPHORIA NATURALS MODERN ESTHETICS & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 WOODSIDE EXECUTIVE CT
AIKEN SC
29803-3814
US

IV. Provider business mailing address

4381 FULCHER RD
HEPHZIBAH GA
30815-5591
US

V. Phone/Fax

Practice location:
  • Phone: 706-627-6005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEE ALICE MOTON
Title or Position: OWNER
Credential: LE
Phone: 706-627-6005