Healthcare Provider Details

I. General information

NPI: 1174219463
Provider Name (Legal Business Name): MIB STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 AVALON PKWY STE 340
MCDONOUGH GA
30253-3054
US

IV. Provider business mailing address

2020 AVALON PKWY STE 340
MCDONOUGH GA
30253-3054
US

V. Phone/Fax

Practice location:
  • Phone: 703-870-4214
  • Fax:
Mailing address:
  • Phone: 703-870-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD MCGANN
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-870-4214