Healthcare Provider Details

I. General information

NPI: 1386865467
Provider Name (Legal Business Name): RENEWED WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 RENEE DR
DECATUR GA
30035-1056
US

IV. Provider business mailing address

1220 RENEE DR
DECATUR GA
30035-1056
US

V. Phone/Fax

Practice location:
  • Phone: 770-686-8744
  • Fax:
Mailing address:
  • Phone: 770-686-8744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name: MS. LOWANDA EVETTE BOWMAN
Title or Position: DIRECTOR
Credential:
Phone: 404-645-8774