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EVERNORTH DIRECT HEALTH LLC NPI 1750659363


NPI Information

NPI: 1750659363
Provider Name: EVERNORTH DIRECT HEALTH LLC

Doing Business As: MOHAWK HEALTHY LIFE CENTER - GREEN STREET

Classification: Non-Pharmacy Dispensing Site - 332900000X
Entity Type: Organization

CLIA Number: 11D2115526

Address:
508 E MORRIS ST
DALTON, GA
ZIP 30721
Phone: (706) 272-1465
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EVERNORTH DIRECT HEALTH LLC is a non pharmacy dispensing site in Dalton, GA. The provider is a site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) EVERNORTH DIRECT HEALTH LLC NPI is 1750659363. The provider is registered as an organization entity type.
The provider Is Doing Business As Mohawk Healthy Life Center - Green Street.

The provider's business location address is:

508 E MORRIS ST
DALTON, GA
ZIP 30721-403
Phone: (706) 272-1465

The provider's authorized official is Kenny Heine .
The authorized official title is Vp Of Operations and has the following contact phone number (858) 625-2990.

The CLIA number assigned to this NPI record is 11D2115526 - other - outpatient with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/9/2011 and was last updated on 5/3/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332900000XNon-Pharmacy Dispensing SiteRN225780GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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