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General NPI Number Information
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NPI Number | 1982410726
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Entity Type | Organization
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Legal Business Name | ETHOS HEALTH GROUP, LLC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1541 SE 17TH ST
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City | OCALA
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State | FL
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Zip | 34471-4607
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Country | US
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Telephone | 352-732-5590
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Fax | 352-732-0292
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Provider Business Mailing Address
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Address Line | 415 COWART AVE STE B
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City | VALDOSTA
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State | GA
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Zip | 31602-2651
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Country | US
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Telephone | 352-732-5590
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | JONATHAN WALKER
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Credential | DC
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Telephone | 352-732-5590
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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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