MEDICARE: PURPLE SWEATER CONSULTING LLC

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	251S00000X	Community/Behavioral Health Agency	4996	GA

General Provider Information

NPI Number	:	1912300997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPLE SWEATER CONSULTING LLC

Provider Business Mailing Address
First Line	:	4661 IVY PATCH DR
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-6897
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5638 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2408
Country	:	US
Telephone Number	:	706-315-5474
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTI OWENS
Credential	:
Telephone Number	:	762-822-3416

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	12/12/2014

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Directions to “PURPLE SWEATER CONSULTING LLC ” Practice Location

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