Healthcare Provider Details

I. General information

NPI: 1710738661
Provider Name (Legal Business Name): PRESTIGE TECH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 EASTER ST
CRYSTAL SPRINGS MS
39059-3021
US

IV. Provider business mailing address

1013 EASTER ST
CRYSTAL SPRINGS MS
39059-3021
US

V. Phone/Fax

Practice location:
  • Phone: 601-431-9973
  • Fax:
Mailing address:
  • Phone: 769-338-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANNETTER CHRISTMAS
Title or Position: CEO/OWNER
Credential:
Phone: 769-338-0134