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General NPI Number Information
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NPI Number | 1457703514
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Entity Type | Organization
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Legal Business Name | THE LYMPH CLINIC LLC
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 2321 HENRY CLOWER BLVD SUITE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-7419
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Country | US
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Telephone | 770-802-4446
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Fax | 770-802-4464
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Provider Business Mailing Address
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Address Line | 2321 HENRY CLOWER BLVD SUITE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-7419
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Country | US
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Telephone | 770-802-4446
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Fax | 770-802-4464
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Authorized Official
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Title or Position | OWNER
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Name | JULIAN DAVIS MILLS WATSON
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Credential |
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Telephone | 770-802-4446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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