MEDICARE: ABSOLUTE HOLISTIC MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center		GA

General Provider Information

NPI Number	:	1336667997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE HOLISTIC MEDICINE

Provider Business Mailing Address
First Line	:	1868 INDEPENDENCE SQ, SUITE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338
Country	:	US
Telephone Number	:	770-393-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1868 INDEPENDENCE SQ, SUITE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338
Country	:	US
Telephone Number	:	770-393-9090
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JITAO BAI
Credential	:
Telephone Number	:	770-393-9090

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	07/21/2022

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