Healthcare Provider Details

I. General information

NPI: 1205100591
Provider Name (Legal Business Name): PREMIER PERSONAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2012
Last Update Date: 08/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 WILKERSON LN
PALMETTO GA
30268-8626
US

IV. Provider business mailing address

6269 GREENOCK DR
STONE MOUNTAIN GA
30087-6081
US

V. Phone/Fax

Practice location:
  • Phone: 404-819-9665
  • Fax: 678-624-6030
Mailing address:
  • Phone: 404-819-9665
  • Fax: 866-624-6594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA YVONNE BRADSHAW-SMALL
Title or Position: CEO
Credential: APRN-BC
Phone: 404-819-9665