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General NPI Number Information
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NPI Number | 1891519864
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Entity Type | Organization
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Legal Business Name | CONCIERGE SPORTS AND FAMILY HEALTH INC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 4300 PACES FERRY RD SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-5714
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Country | US
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Telephone | 404-282-9202
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Fax | 404-282-9202
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Provider Business Mailing Address
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Address Line | 4300 PACES FERRY RD SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-5714
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Country | US
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Telephone | 404-282-9202
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Fax | 404-282-9202
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | NADINE MINES
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Credential |
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Telephone | 404-282-9202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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