Healthcare Provider Details

I. General information

NPI: 1326697731
Provider Name (Legal Business Name): DAISY CONCIERGE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 S. MORRIS RD LT 1
MOULTRIE GA
31768
US

IV. Provider business mailing address

437 S. MORRIS RD LT 1
MOULTRIE GA
31768
US

V. Phone/Fax

Practice location:
  • Phone: 229-529-6473
  • Fax: 800-890-5501
Mailing address:
  • Phone: 229-529-6473
  • Fax: 800-890-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHANTA LACOLE CLAYTON
Title or Position: RN
Credential:
Phone: 229-529-6473