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General NPI Number Information
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NPI Number | 1952536344
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Entity Type | Organization
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Legal Business Name | FIRST HAND EXPERIENCE
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 1874 PIEDMONT RD NE 480D
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City | ATLANTA
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State | GA
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Zip | 30324-4869
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Country | US
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Telephone | 404-226-3590
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Fax |
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Provider Business Mailing Address
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Address Line | 1874 PIEDMONT RD NE 480D
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City | ATLANTA
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State | GA
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Zip | 30324-4869
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Country | US
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Telephone | 404-226-3590
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAY BLOUNT
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Credential | LNMT
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Telephone | 404-226-3590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MT000031
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License Number State | GA
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