Healthcare Provider Details

I. General information

NPI: 1588728117
Provider Name (Legal Business Name): A SUPERIOR CHOICE MEDICAL STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W WIEUCA RD NE
ATLANTA GA
30342-3250
US

IV. Provider business mailing address

130 W WIEUCA RD NE
ATLANTA GA
30342-3250
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-1608
  • Fax: 404-257-1609
Mailing address:
  • Phone: 404-257-1608
  • Fax: 404-257-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number060-R-0154
License Number StateGA

VIII. Authorized Official

Name: MS. JOYCE RODRIGUEZ
Title or Position: ADMINISTATOR
Credential:
Phone: 404-257-1608