Healthcare Provider Details

I. General information

NPI: 1316213150
Provider Name (Legal Business Name): PERSONAL ASSISTANCE OF TOCCOA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E DOYLE ST
TOCCOA GA
30577-2960
US

IV. Provider business mailing address

289A BIG A RD
TOCCOA GA
30577-6019
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-2847
  • Fax: 706-886-0146
Mailing address:
  • Phone: 706-886-2847
  • Fax: 706-886-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number127-R-0934
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MILISSA MICHELLE MARTIN
Title or Position: CEO
Credential:
Phone: 706-886-2847