Forever Young LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

00228865 Issued in GA

Legal business name

FOREVER YOUNG LLC

Practice address

4905 Lavista Rd Ste E
Tucker, GA 30084-4409

Phone

(678) 606-9833

NPI assigned

Sep 9, 2016

Last updated

Sep 9, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

PAIN AND WELLNESS CENTERS OF GAAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Abraham Cohen

Title

Owner

Phone

(770) 680-5740

Specialties & licenses 1

Addresses

Part of

Pain Management Wellness C

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473379200000",
    "number": "1275080921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 LAVISTA RD STE E",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844409",
            "telephone_number": "678-606-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 LAVISTA RD STE E",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844409",
            "telephone_number": "678-606-9833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER YOUNG LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAIN AND WELLNESS CENTERS OF GA",
        "enumeration_date": "2016-09-09",
        "last_updated": "2016-09-09",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-680-5740",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "00228865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Fluellen
• Focus Care Medical Center
• Marcelle Foley
• Levern Fontaine
• Eleni Andria Footman, MD
• Amber Fort, LMFT
• Foundation 33 Wellness
• Harold Weldon Fountain Jr., D.M.D.
• Y Fountain, PHD, LPC, RPT
• Tieshekia Fowlks-

• Specialist in Tucker, GA
• Providers in Tucker, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.