Provider Demographics
NPI:1770044240
Name:POPPY HILL - A SOUTHERN SPA
Entity Type:Organization
Organization Name:POPPY HILL - A SOUTHERN SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RACQUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-429-3817
Mailing Address - Street 1:405 HARRIS TRAIL RD STE D
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4675
Mailing Address - Country:US
Mailing Address - Phone:912-239-5380
Mailing Address - Fax:
Practice Address - Street 1:405 HARRIS TRAIL RD STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-4675
Practice Address - Country:US
Practice Address - Phone:912-239-5380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty