Healthcare Provider Details

I. General information

NPI: 1184167538
Provider Name (Legal Business Name): ANGELIC MEDCERTS & LAB SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5468 HIRAM LITHIA SPRINGS RD
POWDER SPRINGS GA
30127-3512
US

IV. Provider business mailing address

5468 HIRAM LITHIA SPRINGS RD
POWDER SPRINGS GA
30127-3512
US

V. Phone/Fax

Practice location:
  • Phone: 770-899-7102
  • Fax: 770-694-6277
Mailing address:
  • Phone: 770-899-7102
  • Fax: 770-694-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: DONNITA A REYNOLDS
Title or Position: CEO/FOUNDER
Credential:
Phone: 770-899-7102