Healthcare Provider Details

I. General information

NPI: 1750647194
Provider Name (Legal Business Name): METNURSE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WESTRIDGE PKWY SUITE 221
MCDONOUGH GA
30253-3049
US

IV. Provider business mailing address

155 WESTRIDGE PKWY SUITE 221
MCDONOUGH GA
30253-3049
US

V. Phone/Fax

Practice location:
  • Phone: 678-694-7180
  • Fax: 855-874-4592
Mailing address:
  • Phone: 678-694-7180
  • Fax: 855-874-4592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number075-R-0969
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number075-R-0969
License Number StateGA

VIII. Authorized Official

Name: DR. STEPHEN U OKWUADIGBO
Title or Position: ASSISTANT ADMINISTRATOR
Credential: PHD.
Phone: 678-694-7180