Healthcare Provider Details

I. General information

NPI: 1417754771
Provider Name (Legal Business Name): NURTUREPRO CHRONIC CARE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LAGRANGE CT
MACON GA
31210-1475
US

IV. Provider business mailing address

8735 DUNWOODY PL STE R
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 478-217-5721
  • Fax: 478-217-5615
Mailing address:
  • Phone: 478-217-5721
  • Fax: 478-217-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANI BROWN
Title or Position: PRESIDENT
Credential:
Phone: 478-217-5721