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General NPI Number Information
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NPI Number | 1033685946
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Entity Type | Organization
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Legal Business Name | NATIONAL HEALTHCARE AGENCY, LLC
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 3469 LAWRENCEVILLE HWY
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City | TUCKER
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State | GA
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Zip | 30084-5888
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Country | US
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Telephone | 330-212-2535
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 KELLEYS CLOSE
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City | STONE MOUNTAIN
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State | GA
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Zip | 30088-3834
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JEROME IVERY
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Credential |
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Telephone | 330-212-2535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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