Organization
ENER DRIP IV INFUSION & MED SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EARLYCE ROBINSON (OWNER)
(229) 319-8267
Entity
Organization
Contact information
Practice address
3993 LAWRENCEVILLE HWY NW STE 115, LILBURN, GA 30047-2831
(229) 319-8267
Mailing address
399 WAYWARD WIND DR SW, LILBURN, GA 30047-6433
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306853577
MEDICAL DIRECTOR
GA
Enumeration date
04/21/2021
Last updated
05/10/2021
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