Provider Demographics
NPI:1073296554
Name:SPECTRIX METAPHYSICAL INSTITUTE, LTD. CO.
Entity Type:Organization
Organization Name:SPECTRIX METAPHYSICAL INSTITUTE, LTD. CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF METAPHYSICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-320-1984
Mailing Address - Street 1:650 PONCE DE LEON AVE NE STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1864
Mailing Address - Country:US
Mailing Address - Phone:704-320-1984
Mailing Address - Fax:
Practice Address - Street 1:1601 SUMMERWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-3097
Practice Address - Country:US
Practice Address - Phone:470-377-2450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty