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General NPI Number Information
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NPI Number | 1336921006
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Entity Type | Organization
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Legal Business Name | HEALTHY USA COMPANY LLC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 1147 S HAIRSTON RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30088-2720
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Country | US
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Telephone | 404-947-1723
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55255
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City | ATLANTA
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State | GA
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Zip | 30308-5255
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Country | US
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Telephone | 678-462-6636
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEXANDRIA DOMINIQUE PATTERSON
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Credential | FNP
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Telephone | 678-462-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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