Healthcare Provider Details

I. General information

NPI: 1427827534
Provider Name (Legal Business Name): M&M BARKLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 WHISTLE WAY
LOCUST GROVE GA
30248-2065
US

IV. Provider business mailing address

261 WHISTLE WAY
LOCUST GROVE GA
30248-2065
US

V. Phone/Fax

Practice location:
  • Phone: 404-665-7892
  • Fax:
Mailing address:
  • Phone: 404-665-7892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHUNDREKA JUJUAN BARKLEY
Title or Position: OPERATOR
Credential: NP
Phone: 404-828-0454