Healthcare Provider Details

I. General information

NPI: 1982989794
Provider Name (Legal Business Name): A PLACE OF MOTHERLY LOVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4299 BELLWOOD CIRCLE
ATLANTA GA
30349-7074
US

IV. Provider business mailing address

4299 BELLWOOD CIRCLE
ATLANTA GA
30349-7074
US

V. Phone/Fax

Practice location:
  • Phone: 770-969-2539
  • Fax: 770-969-2539
Mailing address:
  • Phone: 770-969-2539
  • Fax: 770-969-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHENEKA HUMPHREY
Title or Position: DIRECTOR
Credential:
Phone: 404-353-9432