Provider Demographics
NPI:1609185537
Name:HOLISTIC HEALTH MANAGEMENT, LLC
Entity Type:Organization
Organization Name:HOLISTIC HEALTH MANAGEMENT, LLC
Other - Org Name:MULTI-CARE HOLISTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-922-2556
Mailing Address - Street 1:1650 HONEY CREEK COMMONS SE
Mailing Address - Street 2:SUITE F
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5831
Mailing Address - Country:US
Mailing Address - Phone:770-922-2556
Mailing Address - Fax:678-210-0280
Practice Address - Street 1:1650 HONEY CREEK COMMONS SE
Practice Address - Street 2:SUITE F
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5831
Practice Address - Country:US
Practice Address - Phone:770-922-2556
Practice Address - Fax:678-210-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005695111N00000X
GA46499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU64704Medicare UPIN
GAF86544Medicare UPIN