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Contact Information

GEORGIA KETAMINE RENEW
1370 THOMPSON BRIDGE RD STE 101
GAINESVILLE, GA30501-1780
 Phone: 678-769-7008
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Acupuncturist

171100000X
 

Medical Specialty

261QM2500X
Indicates primary specialty

NPI Profile & details for GEORGIA KETAMINE RENEW · (Female)

NPI # 1255951182
Status Active
Credentials
Entity Individual
Enumeration date 04/21/2020
Last updated 04/21/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • GA Other 34210 LICENSE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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