Provider Demographics
NPI:1205361748
Name:SHALLOWFORD HERBALS,LLC
Entity Type:Organization
Organization Name:SHALLOWFORD HERBALS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECYTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-760-2235
Mailing Address - Street 1:6021 NEW PEACHTREE RD
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1012
Mailing Address - Country:US
Mailing Address - Phone:770-455-8851
Mailing Address - Fax:770-455-8851
Practice Address - Street 1:6021 NEW PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1012
Practice Address - Country:US
Practice Address - Phone:770-455-8851
Practice Address - Fax:770-455-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty