Provider Demographics
NPI:1164901187
Name:ORCHID VITALITY COLON AND MASSAGE THERAPY
Entity Type:Organization
Organization Name:ORCHID VITALITY COLON AND MASSAGE THERAPY
Other - Org Name:ORCHID VITALITY COLONICS AND MASSAGE THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:LEAD THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:S.
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:MERRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-390-4306
Mailing Address - Street 1:244 14TH ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3696
Mailing Address - Country:US
Mailing Address - Phone:678-390-4306
Mailing Address - Fax:
Practice Address - Street 1:244 14TH ST NE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3696
Practice Address - Country:US
Practice Address - Phone:678-390-4306
Practice Address - Fax:706-661-0249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORCHID VITALITY COLONICS AND MASSAGE THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X, 175F00000X, 175L00000X, 261QH0100X
GAPHTC022614183700000X
GAMT011362225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Single Specialty
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty