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SACRED WATERS LLC NPI 1033546049


NPI Information

NPI: 1033546049
Provider Name: SACRED WATERS, LLC

Doing Business As: SACRED WATERS WELLNESS

Classification: Technician, Other - 247200000X
Entity Type: Organization
Address:
500 LANIER AVE W STE 701
FAYETTEVILLE, GA
ZIP 30214
Phone: (770) 460-9122
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SACRED WATERS, LLC is a technician other in Fayetteville, GA. The provider is a collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user. SACRED WATERS, LLC NPI is 1033546049. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Sacred Waters Wellness.

The provider's business location address is:

500 LANIER AVE W STE 701
FAYETTEVILLE, GA
ZIP 30214-643
Phone: (770) 460-9122

The provider's authorized official is Kelly Jefferson .
The authorized official title is Managing Directo and has the following contact phone number (770) 460-9122.

The enumeration date for this NPI number is 10/4/2013 and was last updated on 10/4/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1247200000XTechnician, OtherGEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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