Healthcare Provider Details

I. General information

NPI: 1134921950
Provider Name (Legal Business Name): MSN NURSING AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 FLAT SHOALS RD SE
CONYERS GA
30013-1968
US

IV. Provider business mailing address

75 CAMERONS WAY
COVINGTON GA
30016-1163
US

V. Phone/Fax

Practice location:
  • Phone: 470-834-6658
  • Fax:
Mailing address:
  • Phone: 678-361-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BENITRA DIANNE TRIPP
Title or Position: ADMINISTRATOR
Credential:
Phone: 678-361-3800