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General NPI Number Information
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NPI Number | 1336571454
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Entity Type | Organization
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Legal Business Name | PROVECTUS HEALTH STRATEGIES, LLC
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 1640 POWERS FERRY RD SE BLDG 26-350
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City | MARIETTA
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State | GA
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Zip | 30067-1443
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Country | US
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Telephone | 912-242-2284
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Fax | 912-882-9262
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Provider Business Mailing Address
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Address Line | 1640 POWERS FERRY RD SE BLDG 26-350
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City | MARIETTA
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State | GA
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Zip | 30067-1443
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Country | US
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Telephone | 912-242-2284
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Fax | 912-882-9262
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Authorized Official
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Title or Position | CEO
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Name | MR. MACK WAYNE BRYSON
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Credential |
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Telephone | 912-242-2284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State | GA
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