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General NPI Number Information
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NPI Number | 1093539686
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Entity Type | Organization
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Legal Business Name | AMPLIFYED HOLDINGS CORP
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 2882 CHURCH ST
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City | EAST POINT
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State | GA
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Zip | 30344-3254
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Country | US
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Telephone | 404-692-8860
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Fax |
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Provider Business Mailing Address
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Address Line | 2882 CHURCH ST
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City | EAST POINT
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State | GA
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Zip | 30344-3254
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Country | US
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Telephone | 404-692-8860
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TACQUORA LASHAE MIXON
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Credential | CMA, CNA
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Telephone | 404-998-6903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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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 | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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