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General NPI Number Information
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NPI Number | 1215273446
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Entity Type | Organization
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Legal Business Name | JUSTFIT BODY MAINTENANCE
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Dates
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Enumeration Date | 12/15/2012
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Last Update Date | 12/15/2012
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Provider Practice Location Address
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Address Line | 2037 MESA DR SE
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City | ATLANTA
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State | GA
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Zip | 30316-4915
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Country | US
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Telephone | 404-713-9382
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Fax |
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Provider Business Mailing Address
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Address Line | 2037 MESA DR SE
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City | ATLANTA
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State | GA
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Zip | 30316-4915
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/REHAB PRACTITIONER
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Name | MR. JUSTIN SPEARS
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Credential |
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Telephone | 404-713-9382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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