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General NPI Number Information
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NPI Number | 1043084080
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Entity Type | Organization
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Legal Business Name | DYNAMIC INFUSION SOLUTIONS POWERED BY FULL PLATE INDUSTRIES, LLC
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 261 SNOW BIRD DR
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City | HAMPTON
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State | GA
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Zip | 30228-3530
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Country | US
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Telephone | 678-469-3718
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Fax |
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Provider Business Mailing Address
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Address Line | 261 SNOW BIRD DR
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City | HAMPTON
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State | GA
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Zip | 30228-3530
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Country | US
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Telephone | 678-469-3718
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEISHA NICOLE FORD
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Credential |
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Telephone | 678-469-3718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #9
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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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