Healthcare Provider Details

I. General information

NPI: 1740805753
Provider Name (Legal Business Name): COMPLETE NURSING CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8305 OFFICE PARK DR STE C
DOUGLASVILLE GA
30134-6935
US

IV. Provider business mailing address

5688 WOODLAND GREENS RD
DOUGLASVILLE GA
30135-5885
US

V. Phone/Fax

Practice location:
  • Phone: 404-316-3631
  • Fax: 678-402-7521
Mailing address:
  • Phone: 404-316-3631
  • Fax: 678-402-7521

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: RONNIE MCKELLER
Title or Position: OWNER
Credential: RN
Phone: 404-316-3631