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General NPI Number Information
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NPI Number | 1902713662
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Entity Type | Organization
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Legal Business Name | HEATHER IVY SOCIETY
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 2193 CASCADE RD SW
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City | ATLANTA
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State | GA
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Zip | 30311-2862
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Country | US
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Telephone | 844-884-9691
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Fax | 404-907-4052
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Provider Business Mailing Address
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Address Line | 2193 CASCADE RD SW
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City | ATLANTA
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State | GA
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Zip | 30311-2862
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Country | US
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Telephone | 844-884-9691
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Fax | 404-907-4052
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ZANDRAETTA TIMS COOK
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Credential |
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Telephone | 615-305-9006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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