Provider Demographics
NPI:1952819179
Name:ATLANTA ACUPUNCTURE AND CHINESE MEDICINE
Entity Type:Organization
Organization Name:ATLANTA ACUPUNCTURE AND CHINESE MEDICINE
Other - Org Name:ATLANTA ACUPUNCTURE AND CHINESE MEDICINE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-368-6196
Mailing Address - Street 1:5775 PEACHTREE DUNWOODY RD STE C200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1509
Mailing Address - Country:US
Mailing Address - Phone:404-368-6196
Mailing Address - Fax:404-368-6196
Practice Address - Street 1:5775 PEACHTREE DUNWOODY RD STE C200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1509
Practice Address - Country:US
Practice Address - Phone:404-368-6196
Practice Address - Fax:404-256-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty