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General NPI Number Information
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NPI Number | 1508318486
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Entity Type | Organization
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Legal Business Name | THRIVE NOW NUTRITION LLC
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 151 TED TURNER DR NW
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City | ATLANTA
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State | GA
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Zip | 30303-2007
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Country | US
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Telephone | 678-465-7118
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Fax |
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Provider Business Mailing Address
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Address Line | 478 DUNBAR ST SW
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City | ATLANTA
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State | GA
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Zip | 30310-3551
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Country | US
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Telephone | 678-592-2166
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | NISHISKSI CHANDLER
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Credential |
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Telephone | 678-465-7118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 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 | GA
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