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General NPI Number Information
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NPI Number | 1811304884
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Entity Type | Organization
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Legal Business Name | THERADOX
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 2705 CHURCH ST SUITE B
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City | EAST POINT
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State | GA
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Zip | 30344-3209
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Country | US
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Telephone | 404-464-8995
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Fax | 404-464-8998
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Provider Business Mailing Address
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Address Line | 2705 CHRUCH STREET SUITE B
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City | EAST POINT
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State | GA
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Zip | 30344
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Country | US
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Telephone | 404-464-8995
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Fax | 404-464-8998
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Authorized Official
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Title or Position | NURSE
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Name | MRS. BEVERLY IDRIS
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Credential |
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Telephone | 404-464-8995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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