Healthcare Provider Details

I. General information

NPI: 1821354630
Provider Name (Legal Business Name): PREMIER PERSONAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6269 GREENOCK DR
STONE MOUNTAIN GA
30087-6081
US

IV. Provider business mailing address

6269 GREENOCK DR
STONE MOUNTAIN GA
30087-6081
US

V. Phone/Fax

Practice location:
  • Phone: 866-446-4547
  • Fax: 678-825-6030
Mailing address:
  • Phone: 866-446-4547
  • Fax: 678-825-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA YVONNE BRADSHAW-SMALL
Title or Position: CEO
Credential: APRN, BC
Phone: 866-447-4547