Provider Demographics
NPI:1619533114
Name:CIRCLE SQUARED PROMOTION
Entity Type:Organization
Organization Name:CIRCLE SQUARED PROMOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL FITNESSTRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:WANYE
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-788-3646
Mailing Address - Street 1:PO BOX 1094
Mailing Address - Street 2:
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288-7000
Mailing Address - Country:US
Mailing Address - Phone:678-788-3646
Mailing Address - Fax:
Practice Address - Street 1:555 WHITEHALL ST SW STE O
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3715
Practice Address - Country:US
Practice Address - Phone:678-788-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health