Healthcare Provider Details

I. General information

NPI: 1588279814
Provider Name (Legal Business Name): MY COMPANION & CONCIERGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 HERODIAN WAY SE STE 220
SMYRNA GA
30080-8500
US

IV. Provider business mailing address

2400 HERODIAN WAY SE STE 220
SMYRNA GA
30080-8500
US

V. Phone/Fax

Practice location:
  • Phone: 678-562-1600
  • Fax:
Mailing address:
  • Phone: 678-562-1600
  • Fax:

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KWANA JONES
Title or Position: OWNER
Credential:
Phone: 678-562-1600