Organization
ANT-AGING QUEEN
Active
Organization
ANT-AGING QUEEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER HNAT LD (OWNER)
(404) 353-3482
Entity
Organization
Contact information
Practice address
1801 ATLANTA MEDICAL CLINIC, SUITE 250, ATLANTA, GA 30309
(404) 353-3482
Mailing address
1801 ATLANTA MEDICAL CLINIC, SUITE 250, ATLANTA, GA 30309
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
LD004146
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023446069
NPI
—
Enumeration date
11/21/2016
Last updated
11/21/2016
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