Organization · Type 2 NPI

Evernorth Direct Health LLC

Non-Pharmacy Dispensing Site · Chatsworth, GA

NPI number 1134412737 Active

Practice location

531 Duvall Rd
Chatsworth, GA 30705-2087

Call (706) 422-6104 Map

Mailing address

5626 Oberlin Dr, Suite 110
San Diego, CA 92121-1705

Specialties and licenses

Taxonomy	Code	License
Non-Pharmacy Dispensing Site Primary	332900000X	002396 (GA)

Non-Pharmacy Dispensing Site: 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.)

NPI record

NPI: 1134412737
Entity type: Organization (Type 2)
Issued: May 16, 2011
Last updated: May 3, 2021
Status: Active
Subpart: Yes of Medvantx, Inc.

Other names

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Mohawk Healthy Life Center - Miles/dvd · doing business as
Mohawk Healthy Life Center - Miles/dvd · doing business as

Authorized official

Kenny Heine
VP of Operations
(858) 625-2990

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1134412737

Evernorth Direct Health LLC's National Provider Identifier is 1134412737, issued on May 16, 2011. The primary taxonomy on file is Non-Pharmacy Dispensing Site (332900000X), and the practice location is in Chatsworth, GA. The record was last updated on May 3, 2021.