NPI 1033546049

Sacred Waters, LLC

Organisation Other Technician Fayetteville, GA

Practice location

Address: 500 Lanier Ave W STE 701, Fayetteville, GA 30214-7643
Phone: (770) 460-9122

Authorised official

Name: Kelly Jefferson
Title: Managing Directo
Phone: (770) 460-9122

Registered specialties

Other Technician Primary

Technologists, Technicians & Other Technical Service Providers Taxonomy 247200000X

Other Technician, Other providers in Georgia →

Registry record

NPI: 1033546049
Entity type: Organization
NPI issued: 4 Oct 2013
Record last updated: 4 Oct 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.