Healthcare Provider Details

I. General information

NPI: 1790557932
Provider Name (Legal Business Name): FULL PLATE INDUSTRIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 SNOW BIRD DR
HAMPTON GA
30228-3530
US

IV. Provider business mailing address

261 SNOW BIRD DR
HAMPTON GA
30228-3530
US

V. Phone/Fax

Practice location:
  • Phone: 678-469-4212
  • Fax:
Mailing address:
  • Phone: 678-469-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEISHA N. FORD-JENRETTE
Title or Position: OWNER
Credential:
Phone: 678-469-4212