MOHAWK HEALTHY LIFE CENTER - GREEN STREET - NPI 1750659363 - Non-Pharmacy Dispensing Site in Dalton, GA

Q: What is the provider's specialty?

The provider's specialty is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

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About Mohawk Healthy Life Center - Green Street NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOHAWK HEALTHY LIFE CENTER - GREEN STREET (NPI 1750659363) is a healthcare organization registered as a non-pharmacy dispensing site in Dalton, Georgia and active in the NPI registry since December 2011. The organization lists Kenny Heine, Vp Of Operations, as its authorized official.

NPPES Registry Identity

NPI1750659363

Entity TypeOrganization

Primary Taxonomy332900000X

Legal Business NameEVERNORTH DIRECT HEALTH LLC

Location Address508 E MORRIS STDalton, GA 30721-3403

Mailing Address5626 Oberlin Dr, Suite 110San Diego, CA 92121-1705

Phone(706) 272-1465

Organization SubpartYesParent: Medvantx, Inc.

Authorized OfficialKenny HeineVp Of Operations · (858) 625-2990

Enumeration DateDecember 9, 2011

Last NPPES UpdateMay 3, 2021

NPPES CertifiedMay 3, 2021

✔ NPI 1750659363 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers

Taxonomy Code332900000X

License✔ Licensed in GA · RN225780

Definition

A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

508 E MORRIS ST, Dalton, GA 30721

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Other Names 1

Doing Business AsMohawk Healthy Life Center - Green Street

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Sanford Health Plan.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2115526

Mohawk Healthy Life Clinic Industrial Park · Dalton, GA

Expired · Jul 7, 2026

CLIA Number11D2115526

Laboratory TypeOutpatient

Certificate Effective DateJuly 8, 2024

Certificate Expiration DateJuly 7, 2026

Laboratory DirectorGabriela Guman

Laboratory Phone(480) 868-0646

Laboratory LocationMohawk Healthy Life Clinic Industrial Park2100 South Hamilton Street, Dalton, GA 30721

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. CARA H BRAMLETT PA-C

Physician Assistant