MEDICARE: PREMIERE TRANSITIONAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1780814780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIERE TRANSITIONAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	3330 CUMBERLAND BLVD
Second Line	:	SUITE 500
City	:	ATLANTA
State	:	GA
Zip	:	30339-5995
Country	:	US
Telephone Number	:	678-612-1212
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 CUMBERLAND BLVD
Second Line	:	SUITE 500
City	:	ATLANTA
State	:	GA
Zip	:	30339-5995
Country	:	US
Telephone Number	:	678-612-1213
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MRS. SONJI SHAZALE WILLINGHAM
Credential	:	MSA
Telephone Number	:	678-612-1213

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	07/24/2009

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