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General NPI Number Information
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NPI Number | 1003484403
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Entity Type | Organization
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Legal Business Name | H.O.P.E. CLINICAL RESEARCH & WELLNESS
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 992 E FREEWAY DR SE STE B
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City | CONYERS
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State | GA
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Zip | 30094-5916
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Country | US
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Telephone | 770-679-5591
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Fax | 770-679-5633
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Provider Business Mailing Address
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Address Line | 992 E FREEWAY DR SE STE B
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City | CONYERS
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State | GA
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Zip | 30094-5916
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Country | US
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Telephone | 770-679-5591
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Fax | 770-679-5633
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Authorized Official
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Title or Position | CHIEF OF MARKETING/CRC
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Name | BONCILLE MATTOX
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Credential | MSN, BSN, RN
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Telephone | 770-679-5591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number |
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License Number State |
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