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General NPI Number Information
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NPI Number | 1003240854
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Entity Type | Organization
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Legal Business Name | GEORGIA ELITE HEALTH, LLC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 2241 LEWIS ST NW
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City | KENNESAW
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State | GA
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Zip | 30144-2714
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Country | US
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Telephone | 678-807-9455
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Fax | 770-545-1973
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Provider Business Mailing Address
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Address Line | PO BOX 815
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City | KENNESAW
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State | GA
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Zip | 30156-0815
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Country | US
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Telephone | 678-807-9455
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Fax | 770-545-6191
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ALICIA MATTHEWS
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Credential | DC
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Telephone | 678-807-9455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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