Provider Demographics
NPI:1235522996
Name:HEALTHY BODY AND SOUL
Entity Type:Organization
Organization Name:HEALTHY BODY AND SOUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:470-266-1550
Mailing Address - Street 1:3461 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:470-266-1550
Mailing Address - Fax:
Practice Address - Street 1:3461 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:470-266-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA285171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1104222538OtherINDIVIDUAL NPI
GA1588920730OtherINDIVIDUAL NPIS