Healthcare Provider Details

I. General information

NPI: 1306092291
Provider Name (Legal Business Name): PRECIOUS RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 UNION CHURCH RD SW
STOCKBRIDGE GA
30281-5430
US

IV. Provider business mailing address

3050 UNION CHURCH RD SW
STOCKBRIDGE GA
30281-5430
US

V. Phone/Fax

Practice location:
  • Phone: 770-860-9588
  • Fax: 770-860-0120
Mailing address:
  • Phone: 770-860-9588
  • Fax: 770-860-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: TERRI DICKINSON
Title or Position: OWNER/PRESIDENT
Credential: PT
Phone: 770-860-9588