Healthcare Provider Details

I. General information

NPI: 1578178984
Provider Name (Legal Business Name): WTT BUSINESS MANAGEMENT CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 03/12/2024
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EAST MAIN ST SUITE 202A
CANTON GA
30114-2781
US

IV. Provider business mailing address

250 EAST MAIN ST SUITE 202A
CANTON GA
30114-2781
US

V. Phone/Fax

Practice location:
  • Phone: 678-880-9128
  • Fax: 770-213-3472
Mailing address:
  • Phone: 678-880-9128
  • Fax: 770-213-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS DALE BLANTON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 912-318-5263