Provider Demographics
NPI:1336571454
Name:PROVECTUS HEALTH STRATEGIES, LLC
Entity Type:Organization
Organization Name:PROVECTUS HEALTH STRATEGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MACK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-242-2284
Mailing Address - Street 1:1640 POWERS FERRY RD SE BLDG 26-350
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-1443
Mailing Address - Country:US
Mailing Address - Phone:912-242-2284
Mailing Address - Fax:912-882-9262
Practice Address - Street 1:1640 POWERS FERRY RD SE BLDG 26-350
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-1443
Practice Address - Country:US
Practice Address - Phone:912-242-2284
Practice Address - Fax:912-882-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization