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General NPI Number Information
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NPI Number | 1346192366
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Entity Type | Organization
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Legal Business Name | 360 MED SPA MANAGEMENT
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 2720 MALL OF GEORGIA BLVD STE 107
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City | BUFORD
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State | GA
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Zip | 30519-8760
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Country | US
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Telephone | 770-932-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 440 CARTER AVE SE
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City | ATLANTA
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State | GA
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Zip | 30317-3244
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Country | US
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Telephone | 323-443-4141
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY GORDON
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Credential |
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Telephone | 770-932-2662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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