Healthcare Provider Details

I. General information

NPI: 1639862576
Provider Name (Legal Business Name): ADAPTABLE CLINICAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2586 WILLOW GROVE RD NW
ACWORTH GA
30101-3030
US

IV. Provider business mailing address

2586 WILLOW GROVE RD NW
ACWORTH GA
30101-3030
US

V. Phone/Fax

Practice location:
  • Phone: 470-424-2818
  • Fax:
Mailing address:
  • Phone: 470-424-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: CHEYENNE DOSS
Title or Position: CEO
Credential: LPN
Phone: 470-424-2818