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General NPI Number Information
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NPI Number | 1003476532
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL MEDICAL SERVICES INC.
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 2710 TURNING LEAF DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7437
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Country | US
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Telephone | 770-638-0084
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 TURNING LEAF DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7437
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Country | US
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Telephone | 770-638-0084
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT (SERVICES)
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Name | SURENDAR AGARWAL
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Credential |
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Telephone | 404-610-5751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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