Healthcare Provider Details

I. General information

NPI: 1841514551
Provider Name (Legal Business Name): MOMMY N ME OF GEORGIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 TRAVERS CREEK TRL
CONYERS GA
30012-3585
US

IV. Provider business mailing address

1376 TRAVERS CREEK TRL
CONYERS GA
30012-3585
US

V. Phone/Fax

Practice location:
  • Phone: 404-784-5536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TIMMEKA GRISSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-784-5526