Healthcare Provider Details

I. General information

NPI: 1801124920
Provider Name (Legal Business Name): ON CALL STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 COLUMBIA RD
MARTINEZ GA
30907-1464
US

IV. Provider business mailing address

4236 COLUMBIA RD
MARTINEZ GA
30907-1464
US

V. Phone/Fax

Practice location:
  • Phone: 706-496-2089
  • Fax: 706-504-4723
Mailing address:
  • Phone: 706-496-2089
  • Fax: 706-504-4723

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 Code372600000X
TaxonomyAdult Companion
License Number036-R-1285
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number036-R-1285
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number036-R-1285
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number036-R-1285
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number036-R-1285
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number036-R-1285
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number16865
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number116865
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number16865
License Number StateGA
# 11
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number16865
License Number StateGA
# 12
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number16865
License Number StateGA
# 13
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number16865
License Number StateGA
# 14
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number16865
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL SWINDLE
Title or Position: OWNER
Credential:
Phone: 706-267-3863