=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164097515
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOR THE LOVE OF HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2021
-----------------------------------------------------
Last Update Date | 05/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3941 OLD ATLANTA STATION DR SE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-1984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-450-7310
-----------------------------------------------------
Fax | 800-450-7310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6595 ROSWELL RD STE G-2387
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-3152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-450-7310
-----------------------------------------------------
Fax | 800-450-7310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | COURTNEY HARRING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-450-7310
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------