Provider Demographics
NPI:1851809875
Name:CREATIVE HEALTH TECHNOLOGIES, LLC
Entity Type:Organization
Organization Name:CREATIVE HEALTH TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-271-7424
Mailing Address - Street 1:2929 WATSON BLVD STE 2-364
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8535
Mailing Address - Country:US
Mailing Address - Phone:404-271-7424
Mailing Address - Fax:404-393-9368
Practice Address - Street 1:198 WILMINGTON DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9020
Practice Address - Country:US
Practice Address - Phone:404-271-7424
Practice Address - Fax:404-393-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies