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General NPI Number Information
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NPI Number | 1053105544
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Entity Type | Organization
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Legal Business Name | HOLDHEIDE EDUCATION COLLEGE PARK
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 5234 OLD HIGHWAY 5
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City | WOODSTOCK
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State | GA
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Zip | 30188
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Country | US
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Telephone | 770-575-4147
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Fax |
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Provider Business Mailing Address
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Address Line | 5234 OLD HIGHWAY 5
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City | WOODSTOCK
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State | GA
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Zip | 30188
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Country | US
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Telephone | 770-575-4147
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMMY MARIE DORSTEN
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Credential |
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Telephone | 770-575-4147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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