Healthcare Provider Details

I. General information

NPI: 1013955194
Provider Name (Legal Business Name): CENTENNIAL PROFESSIONAL THERAPY SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PERIMETER CTR N SUITE 510
ATLANTA GA
30346-3402
US

IV. Provider business mailing address

303 PERIMETER CTR N SUITE 510
ATLANTA GA
30346-3402
US

V. Phone/Fax

Practice location:
  • Phone: 770-379-1035
  • Fax: 770-234-5172
Mailing address:
  • Phone: 770-379-1035
  • Fax: 770-234-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number113146
License Number StateGA

VIII. Authorized Official

Name: MS. NANCY NURNBERG
Title or Position: DIRECTOR
Credential:
Phone: 770-379-1035