Healthcare Provider Details

I. General information

NPI: 1912843384
Provider Name (Legal Business Name): STAR SERVICES ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 KESWICK MANOR DR
TYRONE GA
30290-1540
US

IV. Provider business mailing address

102 KESWICK MANOR DR
TYRONE GA
30290-1540
US

V. Phone/Fax

Practice location:
  • Phone: 229-288-1386
  • Fax:
Mailing address:
  • Phone: 229-288-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State

VIII. Authorized Official

Name: SYKIE BRADWELL
Title or Position: PRESIDENT
Credential:
Phone: 229-288-1386