Provider Demographics
NPI:1982873857
Name:ZONE HEALING CENTER-ATLANTA, LLC
Entity Type:Organization
Organization Name:ZONE HEALING CENTER-ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HURST
Authorized Official - Last Name:PEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-587-0871
Mailing Address - Street 1:931 MONROE DR NE
Mailing Address - Street 2:SUITE C-206
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1793
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:931 MONROE DR NE
Practice Address - Street 2:SUITE C-206
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1793
Practice Address - Country:US
Practice Address - Phone:404-587-0871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008298111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306905807OtherINDIVIDUAL NPI
ALK495OtherMEDICARE GROUP
AL51001163OtherBLUE CROSS/BLUE SHIELD
1306905807OtherINDIVIDUAL NPI