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NPI Code Detail

MEDICARE: SYNERGY SPORTS WELLNESS INSTITUTE

MEDICARE: SYNERGY SPORTS WELLNESS INSTITUTE
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
1111N00000XChiropractorCHIR002950GA

General Provider Information

NPI Number : 1952770851
Entity Type Code : Organization
Provider Name (Legal Business Name) : SYNERGY SPORTS WELLNESS INSTITUTE
Provider Business Mailing Address
First Line : 3565 PIEDMONT RD NE
Second Line : BLDG 2 SUITE 310
City : ATLANTA
State : GA
Zip : 30305-8202
Country : US
Telephone Number : 404-352-8900
Fax Number :
Provider Business Practice Location Address
First Line : 3565 PIEDMONT RD NE
Second Line : BLDG 2 SUITE 310
City : ATLANTA
State : GA
Zip : 30305-8202
Country : US
Telephone Number : 404-352-8900
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MICHAEL HATRAK
Credential :
Telephone Number : 404-352-8900
Provider Enumeration Date : 09/21/2015
Last Update Date : 11/03/2015

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Directions to “SYNERGY SPORTS WELLNESS INSTITUTE ” Practice Location

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