Healthcare Provider Details

I. General information

NPI: 1184568941
Provider Name (Legal Business Name): SBSW MATERNAL SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BLACKGUM TRCE
DALLAS GA
30132-5472
US

IV. Provider business mailing address

24 BLACKGUM TRCE
DALLAS GA
30132-5472
US

V. Phone/Fax

Practice location:
  • Phone: 229-444-2583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARMINA LEWIS
Title or Position: OWNER
Credential: RN
Phone: 229-444-2583