Provider Demographics
NPI:1235561275
Name:WOODRUFF HOLISTIC HEALTH CENTERS, LLC
Entity Type:Organization
Organization Name:WOODRUFF HOLISTIC HEALTH CENTERS, LLC
Other - Org Name:CONYERS HOLISTIC CHIROPRACTIC & NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-648-7445
Mailing Address - Street 1:969 OKELLY ST SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-5470
Mailing Address - Country:US
Mailing Address - Phone:770-648-7445
Mailing Address - Fax:
Practice Address - Street 1:969 OKELLY ST SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5470
Practice Address - Country:US
Practice Address - Phone:770-648-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty