GEORGIA KETAMINE RENEW (NPI# 1255951182) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255951182 |
| Entity Type | Organization |
| Organization Name | GEORGIA KETAMINE RENEW |
| Practice Address |
1370 Thompson Bridge Rd Ste 101 Gainesville GA 30501-1780 |
| Practice Telephone | 6787697008 |
| Mailing Telephone | 6787697008 |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2020-04-21 |
| Authorized Official Name | HEIDI NICHOLSON (OWNER) |
| Authorized Official Telephone | 4044064191 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities | ||
| Y | 171100000X | Acupuncturist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | LICENSE | 34210 | 01 |
| Street Address |
1370 THOMPSON BRIDGE RD STE 101 |
| City | GAINESVILLE |
| State | GA |
| Zip Code | 30501-1780 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578074126 | Sheridan H Spencer | Acupuncturist | 1370 Thompson Bridge Rd Ste 101, Gainesville, GA 30501-1780 | 2017-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437782851 | Madison Raye Huth | Physician Assistant | 743 Spring Street Se, Gainesville, GA 30501 | 2020-02-13 |
| 1205487659 | Grace M Walker Brown | Nurse Practitioner | 592 Medical Park Dr., Suite A, Gainesville, GA 30501 | 2019-09-26 |
| 1174086987 | Nayab Ahmed | Student in an Organized Health Care Education/Training Program | 743 Spring Street, Suite 710, Gainesville, GA 30501 | 2019-04-09 |
| 1154881118 | Ryan D Berry | Student in an Organized Health Care Education/Training Program | 734 Spring St Se Ste 710, Gainesville, GA 30501 | 2019-03-24 |
| 1609336304 | Harper E Niver | Student in an Organized Health Care Education/Training Program | 743 Spring St., Suite 710, Gainesville, GA 30501 | 2019-03-20 |
| 1508336173 | Bradee Burrell Aderholt | Nurse Practitioner | 663 Lanier Park Drive, Gainesville, GA 30501 | 2018-11-27 |
| 1578068359 | Soammy Liz Matias | Chiropractor | 961 Green Street, Gainesville, GA 30501 | 2018-03-26 |
| 1811496896 | Matthew Brown | Speech-Language Pathologist | 500 Spring St. Se Suite 101, Gainesville, GA 30501 | 2018-02-06 |
| 1346769825 | Dr. Skeete & Associates of North Georgia, P.C. | Optometrist | 150 Pearl Nix Parkway, Suite D3a, Gainesville, GA 30501 | 2017-09-15 |
| 1932624723 | M & B Imaging, PC | Radiology | 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 | 2017-08-14 |
| Find all providers in zip 30501 | ||||
| Taxonomy Code | 171100000X |
| Grouping | Other Service Providers |
| Classification | Acupuncturist |
| An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long, fine needles inserted into specific points in order to treat painful conditions or produce anesthesia. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831799808 | Florida Acupuncture and Counseling, LLC | Acupuncturist | 1731 Nw 6th St Ste B3, Gainesville, FL 32609-8515 | 2020-10-29 |
| 1073127106 | Lindsay Brudzinski | Acupuncturist | 920 Nw 8th Ave # A, Gainesville, FL 32601-5071 | 2020-09-05 |
| 1922628049 | Julia R Leavy | Acupuncturist | 1309 Nw 4th St, Gainesville, FL 32601-4200 | 2020-04-18 |
| 1093363574 | David Mansug Park | Acupuncturist | 5200 Newberry Rd Ste D8, Gainesville, FL 32607-2177 | 2019-08-28 |
| 1275005373 | Carolyn Baum | Acupuncturist | 1240 Nw 11th Ave Ste C, Gainesville, FL 32601-4146 | 2018-12-30 |
| 1568937415 | Old Ginseng Herb and Acupuncture, Inc | Acupuncturist | 4001 Newberry Rd Ste C4, Gainesville, FL 32607-2380 | 2018-10-08 |
| 1679048599 | Hongchi Chou | Acupuncturist | 4001 W Newberry Rd Ste C4, Gainesville, FL 32607-2380 | 2018-10-07 |
| 1467954271 | Angie Middleton LLC | Acupuncturist | 1200 Nw 36th Rd, Gainesville, FL 32609-2103 | 2018-03-07 |
| 1578074126 | Sheridan H Spencer | Acupuncturist | 1370 Thompson Bridge Rd Ste 101, Gainesville, GA 30501-1780 | 2017-10-21 |
| 1376060301 | Healing Elements Integrative Acupuncture LLC | Acupuncturist | 305 Se 2cd Ave, Gainesville, FL 32601 | 2017-08-30 |
| Find all providers in GAINESVILLE | ||||
| City | GAINESVILLE |
| Zip Code | 30501 |
Please comment or provide details below to improve the information on GEORGIA KETAMINE RENEW.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.