Provider Demographics
NPI:1356620454
Name:SUPPORTING YOUR DAILY HEALTH, LLC
Entity type:Organization
Organization Name:SUPPORTING YOUR DAILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:404-790-0911
Mailing Address - Street 1:3695 CASCADE RD SW STE F
Mailing Address - Street 2:STE 1158
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2146
Mailing Address - Country:US
Mailing Address - Phone:404-438-7569
Mailing Address - Fax:
Practice Address - Street 1:147 NORTH AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2328
Practice Address - Country:US
Practice Address - Phone:404-438-7569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005833111NI0013X
GA004315363AM0700X
GA65587207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty