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NPI Code Detail

MEDICARE: THRIVE NOW NUTRITION LLC

MEDICARE: THRIVE NOW NUTRITION LLC
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
1251S00000XCommunity/Behavioral Health AgencyGA
2251X00000XSupports Brokerage AgencyGA
3253Z00000XIn Home Supportive Care Agency
4251K00000XPublic Health or Welfare AgencyGA

General Provider Information

NPI Number : 1508318486
Entity Type Code : Organization
Provider Name (Legal Business Name) : THRIVE NOW NUTRITION LLC
Provider Business Mailing Address
First Line : 478 DUNBAR ST SW
Second Line :
City : ATLANTA
State : GA
Zip : 30310-3551
Country : US
Telephone Number : 678-592-2166
Fax Number :
Provider Business Practice Location Address
First Line : 151 TED TURNER DR NW
Second Line :
City : ATLANTA
State : GA
Zip : 30303-2007
Country : US
Telephone Number : 678-465-7118
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : NISHISKSI CHANDLER
Credential :
Telephone Number : 678-465-7118
Provider Enumeration Date : 10/26/2016
Last Update Date : 03/22/2017

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Directions to “THRIVE NOW NUTRITION LLC ” Practice Location

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