Healthcare Provider Details

I. General information

NPI: 1346901188
Provider Name (Legal Business Name): SMB NURSING CONCIERGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 WORTH CT
RIVERDALE GA
30296-2263
US

IV. Provider business mailing address

1003 WORTH CT
RIVERDALE GA
30296-2263
US

V. Phone/Fax

Practice location:
  • Phone: 205-863-8584
  • Fax: 541-717-8170
Mailing address:
  • Phone: 205-863-8584
  • Fax: 541-717-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. STEPHANIE NICOLE MADISON-BRYANT
Title or Position: OWNER
Credential: DNP MSN RN-BC
Phone: 205-863-8584