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1396868824 NPI number — HEALTH REJUVENATIONS CONSULTANT, INC.

NPI Number: 1396868824
Health Care Provider/Practitioner: HEALTH REJUVENATIONS CONSULTANT, INC.

Information about “1396868824” NPI (HEALTH REJUVENATIONS CONSULTANT, INC.) exists in 1396868824 in HTML format HTML  |  1396868824 in plain Text format TXT  |  1396868824 in PDF (Portable Document Format) PDF  |  1396868824 in an XML format XML  formats.

NPI Number : 1396868824 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396868824",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "HEALTH REJUVENATIONS CONSULTANT, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4588 BOULDERCREST RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ELLENWOOD",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30294-3613",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "404-731-6107",
    "MailingAddressFaxNumber": "404-366-9947",
    "FirstLinePracticeLocationAddress": "194 JONESBORO RD",
    "SecondLinePracticeLocationAddress": "SUITE A-6",
    "PracticeLocationAddressCityName": "JONESBORO",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30236-4812",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "404-731-6107",
    "PracticeLocationAddressFaxNumber": "404-366-9947",
    "EnumerationDate": "04/09/2007",
    "LastUpdateDate": "06/08/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PATILLO",
    "AuthorizedOfficialFirstName": "DORIS",
    "AuthorizedOfficialMiddleName": "D'NIN",
    "AuthorizedOfficialTitle": "CEO-PSYCHOLOGIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PSYD. L.P.C., CACII",
    "AuthorizedOfficialTelephoneNumber": "404-731-6107",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "1594",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": "004196",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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