Organization
POSITIVE INNERGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT HORSFORD (OWNER)
(770) 990-0823
Entity
Organization
Contact information
Practice address
26 POTOMAC AVE, GREENVILLE, SC 29605-2118
(770) 990-0823
Mailing address
5461 FESTIVAL AVE, FAIRBURN, GA 30213-5502
(770) 990-0823
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/19/2019
Last updated
09/19/2019
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