Georgia Ketamine Renew
LBN: Georgia Ketamine Renew
Georgia Ketamine Renew is an health care organization with primary practice located at 1370 Thompson Bridge Rd Ste 101 , Gainesville GA 30501-1780. The organization recently has 2 registered licenses in different health care specialties including Other Service Providers / Acupuncturist, Ambulatory Health Care Facilities / Medical Specialty. Other Service Providers / Acupuncturist is the primary health care specialty.
Georgia Ketamine Renew can be contacted via phone (678) 769-7008, or through Nicholson, Heidi via phone (404) 406-4191.
Contact Information
Primary practice address
1370 Thompson Bridge Rd Ste 101
Gainesville GA 30501-1780
Phone: (678) 769-7008
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Acupuncturist | 171100000X | ||
| Ambulatory Health Care Facilities / Medical Specialty | 261QM2500X |
Profile Details
| NPI number | 1255951182 |
|---|---|
| LBN Legal business name | Georgia Ketamine Renew |
| DBA Doing business as | |
| Authorized official | Nicholson, Heidi Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 21st, 2020 |
| Last updated | Apr 21st, 2020 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255951182 | NPPES |
| Georgia | Other | 34210 | LICENSE |
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