Healthcare Provider Details

I. General information

NPI: 1811642978
Provider Name (Legal Business Name): PCA ELITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3937 HOLCOMB BRIDGE RD STE 201
PEACHTREE CORNERS GA
30092-2249
US

IV. Provider business mailing address

3937 HOLCOMB BRIDGE RD STE 201
PEACHTREE CORNERS GA
30092-2249
US

V. Phone/Fax

Practice location:
  • Phone: 404-720-0770
  • Fax:
Mailing address:
  • Phone: 404-720-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHELSEA LOTT
Title or Position: OWNER/ ADMIN
Credential:
Phone: 678-656-6647