Healthcare Provider Details

I. General information

NPI: 1366191587
Provider Name (Legal Business Name): QUALITYCARE MEDICAL CONCIERGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 CATHY ST
SAVANNAH GA
31415-7805
US

IV. Provider business mailing address

#1018 1915 E. VICTORY DRIVE SUITE E
SAVANNAH GA
31404
US

V. Phone/Fax

Practice location:
  • Phone: 912-631-6448
  • Fax:
Mailing address:
  • Phone: 912-662-6319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ANGEL RACHAEL JOHNSON
Title or Position: MANAGING PARTNER
Credential: AHI, CPT
Phone: 912-631-6448