Provider Demographics
NPI:1235569344
Name:MASTERPIECEWITHIN
Entity Type:Organization
Organization Name:MASTERPIECEWITHIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:MCCLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-913-9169
Mailing Address - Street 1:2164 HIDDEN GLEN DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8740
Mailing Address - Country:US
Mailing Address - Phone:678-913-9169
Mailing Address - Fax:
Practice Address - Street 1:2164 HIDDEN GLEN DR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8740
Practice Address - Country:US
Practice Address - Phone:678-913-9169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL1230175302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization