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General NPI Number Information
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NPI Number | 1871173005
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Entity Type | Organization
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Legal Business Name | ATLAS INTEGRATED HEALTH LLC
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 4740 N BUTLER AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-0826
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Country | US
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Telephone | 505-325-2604
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Fax | 505-327-1976
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Provider Business Mailing Address
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Address Line | 4740 N BUTLER AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-0826
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Country | US
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Telephone | 505-325-2604
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Fax | 505-327-1976
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Authorized Official
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Title or Position | REGISTERED AGENT/MANAGER
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Name | DR. ERICA SUSSEX-GRANT
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Credential | DC
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Telephone | 505-325-2604
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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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