Healthcare Provider Details

I. General information

NPI: 1417298282
Provider Name (Legal Business Name): XTRA PAIR OF HANDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 EASTVIEW PKWY SUITE 105
CONYERS GA
30013-5770
US

IV. Provider business mailing address

2004 EASTVIEW PKWY SUITE 105
CONYERS GA
30013-5770
US

V. Phone/Fax

Practice location:
  • Phone: 404-825-4398
  • Fax:
Mailing address:
  • Phone: 404-855-4592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KYM SMITH
Title or Position: MANAGER
Credential:
Phone: 404-825-4398