Healthcare Provider Details

I. General information

NPI: 1750139986
Provider Name (Legal Business Name): A GOLDEN MOMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 LAKEVIEW RD
GRAYSON GA
30017-1146
US

IV. Provider business mailing address

2330 SCENIC HWY S
SNELLVILLE GA
30078-3115
US

V. Phone/Fax

Practice location:
  • Phone: 770-656-1522
  • Fax:
Mailing address:
  • Phone: 470-798-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. TAKIYAH JONES
Title or Position: FOUNDER
Credential: NP
Phone: 770-656-1522