Healthcare Provider Details

I. General information

NPI: 1740670819
Provider Name (Legal Business Name): A NICKLE AND A NAIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 PARKER AVE
ALBANY GA
31707-3920
US

IV. Provider business mailing address

1218 PARKER AVE
ALBANY GA
31707-3920
US

V. Phone/Fax

Practice location:
  • Phone: 229-888-3575
  • Fax:
Mailing address:
  • Phone: 229-888-3575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberPCH008516
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberPCH008516
License Number StateGA

VIII. Authorized Official

Name: MS. JANICE TEEMER
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 229-888-3575