Provider Demographics
NPI:1548516164
Name:CHN HEALTHY CLINIC
Entity type:Organization
Organization Name:CHN HEALTHY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-334-2485
Mailing Address - Street 1:650 HENDERSON DR
Mailing Address - Street 2:SUITE 504
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3744
Mailing Address - Country:US
Mailing Address - Phone:770-334-2485
Mailing Address - Fax:770-387-1458
Practice Address - Street 1:650 HENDERSON DR
Practice Address - Street 2:SUITE 504
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3744
Practice Address - Country:US
Practice Address - Phone:770-334-2485
Practice Address - Fax:770-387-1458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172939261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care