Organization
KIDZ FITNESS STATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASYA JOY SMITH (OWNER)
(404) 279-0598
Entity
Organization
Contact information
Practice address
2460 TERRY RD, JACKSON, MS 39204-5767
(404) 279-0598
Mailing address
1389 MUNDYS MILL RD, JONESBORO, GA 30238-6082
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
Other
Enumeration date
12/02/2013
Last updated
03/16/2016
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