Provider Demographics
NPI:1255595716
Name:A SYNERGISTIC APPROACH
Entity type:Organization
Organization Name:A SYNERGISTIC APPROACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:JANELL
Authorized Official - Last Name:IDIAQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:770-313-0106
Mailing Address - Street 1:4685 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:J3
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6323
Mailing Address - Country:US
Mailing Address - Phone:770-313-0106
Mailing Address - Fax:404-474-7031
Practice Address - Street 1:328 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3235
Practice Address - Country:US
Practice Address - Phone:770-313-0106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000063171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty