Healthcare Provider Details

I. General information

NPI: 1689506271
Provider Name (Legal Business Name): MEDPRO INDEPENDENT LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 SCENIC WAY SW
LILBURN GA
30047-6724
US

IV. Provider business mailing address

1269 SCENIC WAY SW
LILBURN GA
30047-6724
US

V. Phone/Fax

Practice location:
  • Phone: 404-488-9839
  • Fax: 800-504-1362
Mailing address:
  • Phone: 404-488-9839
  • Fax: 800-504-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA HOWARD
Title or Position: OWNER
Credential:
Phone: 404-488-9839