Healthcare Provider Details

I. General information

NPI: 1366319220
Provider Name (Legal Business Name): OPAL AND OATH CONCIERGE NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 PRINCETON DR
DALLAS GA
30157-0853
US

IV. Provider business mailing address

327 PRINCETON DR
DALLAS GA
30157-0853
US

V. Phone/Fax

Practice location:
  • Phone: 470-762-9712
  • Fax:
Mailing address:
  • Phone: 470-762-9712
  • 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: LAUREN CAMPBELL
Title or Position: OWNER
Credential:
Phone: 470-762-9712