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NPI 1346526530

OrganizationActive

Back to Life Medical Group, LLC

NPI 1346526530 · Non-Pharmacy Dispensing Site · Canton, GA

Provider details

NPI number: 1346526530
Entity type: Organization
Primary specialty: Non-Pharmacy Dispensing SiteSuppliers
Parent organization: Back to Life Medical Group, LLC
Authorized official: Satish Cuddapah, Medical Director

Practice location

557 Riverstone Pkwy

Suite 140

Canton, GA 30114-5223

Phone: (770) 345-2000

Fax: (770) 345-4524

More GA providers

Mailing address

557 Riverstone Pkwy

Canton, GA 30114-5223

Registry dates

Enumerated: 2011-11-01
Last updated: 2015-06-22

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Back to Life Medical Group, LLC — NPI 1346526530, Canton, GA | NPI Central