Healthcare Provider Details

I. General information

NPI: 1609694637
Provider Name (Legal Business Name): SAPPHIRE AND SON'S CONSTRUCTION COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 MILSTEAD RD NE STE 102
CONYERS GA
30012-3824
US

IV. Provider business mailing address

1315 MILSTEAD RD NE STE 102
CONYERS GA
30012-3824
US

V. Phone/Fax

Practice location:
  • Phone: 470-217-8445
  • Fax: 470-300-7778
Mailing address:
  • Phone: 470-217-8445
  • Fax: 470-300-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: ELLA STEPHENSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 470-217-8445