Provider Demographics
NPI:1457703514
Name:THE LYMPH CLINIC LLC
Entity Type:Organization
Organization Name:THE LYMPH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:MILLS WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-802-4446
Mailing Address - Street 1:2321 HENRY CLOWER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7419
Mailing Address - Country:US
Mailing Address - Phone:770-802-4446
Mailing Address - Fax:770-802-4464
Practice Address - Street 1:2321 HENRY CLOWER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7419
Practice Address - Country:US
Practice Address - Phone:770-802-4446
Practice Address - Fax:770-802-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty