Provider Demographics
NPI:1922404847
Name:ACUPUNCTURE HERBS CLINIC INC
Entity Type:Organization
Organization Name:ACUPUNCTURE HERBS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHINESE MEDICINE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AKINYI
Authorized Official - Middle Name:
Authorized Official - Last Name:OSANO
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM, LAC, DAC
Authorized Official - Phone:888-871-1884
Mailing Address - Street 1:P.O. BOX 6864
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135
Mailing Address - Country:US
Mailing Address - Phone:888-871-1884
Mailing Address - Fax:
Practice Address - Street 1:7193 DOUGLAS BLVD
Practice Address - Street 2:SUITE 102D
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1540
Practice Address - Country:US
Practice Address - Phone:678-908-7191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAP325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty