Healthcare Provider Details

I. General information

NPI: 1427930247
Provider Name (Legal Business Name): MUTATIO WORLDWIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 NATHAN DEAN BLVD STE 105-357
DALLAS GA
30132-4911
US

IV. Provider business mailing address

457 NATHAN DEAN BLVD STE 105-357
DALLAS GA
30132-4911
US

V. Phone/Fax

Practice location:
  • Phone: 706-883-5656
  • Fax: 706-883-5656
Mailing address:
  • Phone: 706-883-5656
  • Fax: 706-883-5656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS TYRONE JENKINS
Title or Position: PRESIDENT
Credential:
Phone: 770-589-2141