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General NPI Number Information
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NPI Number | 1578692430
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR HOLISTIC HEALTH
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 320 WINN WAY STE 101
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City | DECATUR
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State | GA
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Zip | 30030-2106
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Country | US
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Telephone | 404-929-0604
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Fax | 404-477-0894
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Provider Business Mailing Address
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Address Line | 320 WINN WAY STE 101
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City | DECATUR
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State | GA
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Zip | 30030-2106
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Country | US
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Telephone | 404-929-0604
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Fax | 404-477-0894
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Authorized Official
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Title or Position | OWNER
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Name | GENE CLERKIN
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Credential | DO
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Telephone | 404-929-0604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 05215
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License Number State | GA
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