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General NPI Number Information
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NPI Number | 1861726275
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Entity Type | Organization
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Legal Business Name | A PLUS TOTAL HEALTH CONNECTION LLC
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 333 SWANSON DR STE 102
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8537
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Country | US
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Telephone | 678-878-3069
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Fax | 678-878-4455
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Provider Business Mailing Address
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Address Line | PO BOX 490186
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City | LAWRENCEVILLE
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State | GA
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Zip | 30049-0004
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Country | US
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Telephone | 678-878-3069
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Fax | 678-878-4455
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Authorized Official
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Title or Position | OWNER
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Name | DR. BODANIELLE SUC PARK
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Credential | M.D, PHDOM, L. AC.
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Telephone | 678-878-3069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 355
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License Number State | GA
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