| Abundant Living Foundation, Inc. | |
|
1558 Marietta Hwy Ste 200 Canton GA 30114-3615 | |
| (914) 275-1477 | |
| Not Available |
| Full Name | Abundant Living Foundation, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1558 Marietta Hwy Ste 200, Canton, Georgia |
| Authorized Official Name and Position | Evelynmarie Sabrinah Dorce (FOUNDER AND EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4042828292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abundant Living Foundation, Inc. 840 Commerce Trl Canton GA 30114-7572 Ph: (914) 275-1477 | Abundant Living Foundation, Inc. 1558 Marietta Hwy Ste 200 Canton GA 30114-3615 Ph: (914) 275-1477 |
| NPI Number | 1033973854 |
|---|---|
| Provider Enumeration Date | 02/12/2024 |
| Last Update Date | 02/12/2024 |
| Medicare PECOS PAC ID | 3173059979 |
|---|---|
| Medicare Enrollment ID | O20241203003828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033973854 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Secondary |
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