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Organization
SACRED WATERS, LLC
Active
Organization
SACRED WATERS, LLC
Active
Other names
Sacred Waters Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY JEFFERSON (MANAGING DIRECTO)
(770) 460-9122
Entity
Organization
Contact information
Practice address
500 LANIER AVE W STE 701, FAYETTEVILLE, GA 30214-7643
(770) 460-9122
Mailing address
500 LANIER AVE W STE 701, FAYETTEVILLE, GA 30214-7643
(770) 460-9122
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
GA
Other
Enumeration date
10/04/2013
Last updated
10/04/2013
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