Healthcare Provider Details

I. General information

NPI: 1265005573
Provider Name (Legal Business Name): M & W ROYAL STAFFING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 LINDSEY DR
DECATUR GA
30035-1927
US

IV. Provider business mailing address

4266 LINDSEY DR
DECATUR GA
30035-1927
US

V. Phone/Fax

Practice location:
  • Phone: 470-965-3741
  • Fax:
Mailing address:
  • Phone: 470-965-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICE M JACKSON-WEATHERS
Title or Position: OWNER
Credential: CNA
Phone: 470-965-3741