Healthcare Provider Details

I. General information

NPI: 1093052359
Provider Name (Legal Business Name): THIRD DAY MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2064 RIDGEDALE RD NE
ATLANTA GA
30317
US

IV. Provider business mailing address

2064 RIDGEDALE RD NE
ATLANTA GA
30317
US

V. Phone/Fax

Practice location:
  • Phone: 888-719-5445
  • Fax: 678-805-4743
Mailing address:
  • Phone: 888-719-5445
  • Fax: 678-805-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License NumberLPN059388
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberLPN059388
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberLPN059388
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberLPN059388
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLPN059388
License Number StateGA

VIII. Authorized Official

Name: DR. CARLA BERNITA JONES
Title or Position: PROGRAM MANAGER
Credential: DOCTORATE DEGREE
Phone: 888-719-5445