Provider Demographics
NPI:1134559099
Name:ACUPUNCTURE HERBS CLINIC
Entity type:Organization
Organization Name:ACUPUNCTURE HERBS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHINESE MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AKINYI
Authorized Official - Middle Name:S
Authorized Official - Last Name:OSANO
Authorized Official - Suffix:
Authorized Official - Credentials:DAC, DOM, LAC
Authorized Official - Phone:678-908-7191
Mailing Address - Street 1:7193 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 102 D
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1540
Mailing Address - Country:US
Mailing Address - Phone:678-908-7191
Mailing Address - Fax:
Practice Address - Street 1:5390 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4715
Practice Address - Country:US
Practice Address - Phone:678-908-7191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALICENCE NO 325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty