Healthcare Provider Details

I. General information

NPI: 1184124877
Provider Name (Legal Business Name): NURSING COMPANION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 DUKE DR
CONYERS GA
30013
US

IV. Provider business mailing address

P.O. BOX 83256
CONYERS GA
30013-2938
US

V. Phone/Fax

Practice location:
  • Phone: 678-480-7612
  • Fax:
Mailing address:
  • Phone: 678-480-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number122-R-1680
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number122-R-1680
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number122-R-1680
License Number StateGA

VIII. Authorized Official

Name: MRS. ANNA UGOCHUKWU
Title or Position: CEO
Credential: R.N.
Phone: 678-480-7612