Provider Demographics
NPI:1861726275
Name:A PLUS TOTAL HEALTH CONNECTION LLC
Entity type:Organization
Organization Name:A PLUS TOTAL HEALTH CONNECTION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BODANIELLE
Authorized Official - Middle Name:SUC
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHDOM, L AC
Authorized Official - Phone:678-878-3069
Mailing Address - Street 1:PO BOX 490186
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0004
Mailing Address - Country:US
Mailing Address - Phone:678-878-3069
Mailing Address - Fax:678-878-4455
Practice Address - Street 1:333 SWANSON DR STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8537
Practice Address - Country:US
Practice Address - Phone:678-878-3069
Practice Address - Fax:678-878-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA355171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty