Provider Demographics
NPI:1033973854
Name:ABUNDANT LIVING FOUNDATION, INC.
Entity Type:Organization
Organization Name:ABUNDANT LIVING FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYNMARIE
Authorized Official - Middle Name:SABRINAH
Authorized Official - Last Name:DORCE
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP)
Authorized Official - Phone:404-282-8292
Mailing Address - Street 1:840 COMMERCE TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7572
Mailing Address - Country:US
Mailing Address - Phone:914-275-1477
Mailing Address - Fax:
Practice Address - Street 1:1558 MARIETTA HWY STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3615
Practice Address - Country:US
Practice Address - Phone:914-275-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No291U00000XLaboratoriesClinical Medical Laboratory