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General NPI Number Information
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NPI Number | 1114330362
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY WELLNESS, L.L.C.
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 555 SUN VALLEY DR STE A3
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City | ROSWELL
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State | GA
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Zip | 30076-5606
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Country | US
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Telephone | 770-485-7101
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Fax |
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Provider Business Mailing Address
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Address Line | 555 SUN VALLEY DR STE A3
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City | ROSWELL
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State | GA
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Zip | 30076-5606
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Country | US
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Telephone | 770-485-7101
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | AYYANA BURVICK
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Credential |
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Telephone | 770-485-7101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CHIR008909
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License Number State | GA
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