Provider Demographics
NPI:1659839439
Name:HORNBURG HOLISTICS, LLC
Entity Type:Organization
Organization Name:HORNBURG HOLISTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:770-309-9239
Mailing Address - Street 1:5150 STILESBORO RD NW STE 620
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7760
Mailing Address - Country:US
Mailing Address - Phone:770-309-9239
Mailing Address - Fax:
Practice Address - Street 1:5150 STILESBORO RD NW STE 620
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7760
Practice Address - Country:US
Practice Address - Phone:770-309-9239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center