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General NPI Number Information
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NPI Number | 1164901187
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Entity Type | Organization
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Legal Business Name | ORCHID VITALITY COLON AND MASSAGE THERAPY
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 244 14TH ST NE STE B
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City | ATLANTA
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State | GA
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Zip | 30309-3696
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Country | US
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Telephone | 678-390-4306
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Fax | 706-661-0249
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Provider Business Mailing Address
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Address Line | 244 14TH ST NE STE B
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City | ATLANTA
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State | GA
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Zip | 30309-3696
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Country | US
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Telephone | 678-390-4306
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Fax |
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Authorized Official
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Title or Position | LEAD THERAPIST
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Name | MRS. S. YVETTE MERRIMAN
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Credential |
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Telephone | 678-390-4306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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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 | 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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Taxonomy #3
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Taxonomy Code | 175L00000X
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Taxonomy Name | Homeopath
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PHTC022614
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License Number State | GA
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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 | MT011362
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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