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General NPI Number Information
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NPI Number | 1063229268
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Entity Type | Organization
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Legal Business Name | MOUNTAIN OVER EARTH LLC
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 112 PROFESSIONAL RD STE 1
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City | BLUE RIDGE
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State | GA
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Zip | 30513-7350
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Country | US
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Telephone | 619-751-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 857 MOUNTAIN RIVERS LN
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City | MINERAL BLUFF
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State | GA
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Zip | 30559-7922
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Country | US
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Telephone | 619-751-6904
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST / OWNER
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Name | DR. JAIME FRITSCH
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Credential | DACM, L.AC.
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Telephone | 619-751-6904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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