Healthcare Provider Details

I. General information

NPI: 1912698416
Provider Name (Legal Business Name): A PLACE OF PEACE PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 BOCA RATON DR
FOREST PARK GA
30297-3445
US

IV. Provider business mailing address

1700 NORTHSIDE DRIVE STE. A7 PMB 3200
ATLANTA GA
30318
US

V. Phone/Fax

Practice location:
  • Phone: 678-600-3298
  • Fax:
Mailing address:
  • Phone: 678-600-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON WEATHERSPOON
Title or Position: OWNER
Credential:
Phone: 678-964-9199