# GOLDEN BLOOM PHRAMS INC

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

## Provider details

- **NPI number:** 1962007252
- **Authorized official:** JESSICA LANE (PRESIDENT)
- **Authorized official phone:** (770) 633-8550

## Contact information

- **Practice address:** 1172 OLD SALEM RD SE, CONYERS, GA 30094-5944
- **Practice address phone:** (770) 633-8550
- **Mailing address:** 1172 OLD SALEM RD SE, CONYERS, GA 30094-5944
- **Mailing address phone:** (770) 633-8550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 12/03/2020
- **Last updated:** 12/03/2020