Provider Demographics
NPI:1760095202
Name:TWO DRAGONS TAI CHI LLC
Entity Type:Organization
Organization Name:TWO DRAGONS TAI CHI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-624-6151
Mailing Address - Street 1:4373 MARJORIE RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6538
Mailing Address - Country:US
Mailing Address - Phone:404-624-6151
Mailing Address - Fax:770-860-1815
Practice Address - Street 1:4373 MARJORIE RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6538
Practice Address - Country:US
Practice Address - Phone:404-624-6151
Practice Address - Fax:770-860-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty