# BIG HART WELLNESS AND SPORTS ACADEMY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396120291
- **Authorized official:** MR. EDGERTON HARTWELL (PRESIDENT)
- **Authorized official phone:** (702) 301-4432

## Contact information

- **Practice address:** 2021 W LIDDELL RD, SUITE B, DULUTH, GA 30096-8831
- **Practice address phone:** (702) 301-4432
- **Mailing address:** 5991 THOMPSON MILL RD, HOSCHTON, GA 30548-4029
- **Mailing address phone:** (702) 301-4432

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174H00000X | Health Educator | — | NULL | Yes |
| 174H00000X | Health Educator | — | — | Yes |
| 251T00000X | PACE Provider Organization | — | NULL | — |

## Other

- **Enumeration date:** 07/22/2015
- **Last updated:** 07/22/2015