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General NPI Number Information
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NPI Number | 1154769834
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Entity Type | Organization
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Legal Business Name | LADY C SERVICES LLC.
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 5152 MEMORIAL DR UNIT 830627
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-0106
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Country | US
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Telephone | 404-838-9513
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Fax |
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Provider Business Mailing Address
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Address Line | 5152 MEMORIAL DR UNIT 830627
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-0106
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Country | US
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Telephone | 404-838-9513
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CONNIELYNNE WILLIAMSON
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Credential | 4048389513
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Telephone | 404-838-9513
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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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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice 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 | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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