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General NPI Number Information
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NPI Number | 1083989669
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Entity Type | Organization
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Legal Business Name | UNIQUE-N-ASSURANCE HEALTHCARE AGENCY LLC
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 910 ARROWHEAD TRL # GA31088
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City | WARNER ROBINS
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State | GA
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Zip | 31088-5372
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Country | US
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Telephone | 888-541-5552
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2145
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-8909
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Country | US
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Telephone | 888-541-5552
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GWENDOLYN DUMAS
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Credential |
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Telephone | 478-228-1422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 076-R-1011
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License Number State | GA
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