Provider Demographics
NPI:1164201836
Name:DEE ALICE MOTON HCSR
Entity Type:Organization
Organization Name:DEE ALICE MOTON HCSR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEE ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-627-6005
Mailing Address - Street 1:5150 WOODSIDE EXECUTIVE CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-3814
Mailing Address - Country:US
Mailing Address - Phone:706-627-6005
Mailing Address - Fax:888-807-5411
Practice Address - Street 1:6350 WOODSIDE EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3825
Practice Address - Country:US
Practice Address - Phone:706-951-5812
Practice Address - Fax:888-807-5411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EUPHORIA NATURALS MODERN ESTHETICS &WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty