Provider Demographics
NPI:1891571634
Name:DRIPS IN MOTION INFUSION BAR LLC
Entity Type:Organization
Organization Name:DRIPS IN MOTION INFUSION BAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ETOYUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:404-451-4052
Mailing Address - Street 1:1360 DOGWOOD DR SE STE 104
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5077
Mailing Address - Country:US
Mailing Address - Phone:404-451-4052
Mailing Address - Fax:
Practice Address - Street 1:1360 DOGWOOD DR SE STE 104
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5077
Practice Address - Country:US
Practice Address - Phone:404-451-4052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty