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General NPI Number Information
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NPI Number | 1275288656
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Entity Type | Organization
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Legal Business Name | PMR HEALTH CARE AGENCY LLC
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 200 SOUTHSIDE DR SE
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-4375
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Country | US
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Telephone | 470-307-7358
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Fax |
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Provider Business Mailing Address
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Address Line | 173 HIGHVIEW RD SE
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-8187
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Country | US
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Telephone | 470-307-7358
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Fax |
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Authorized Official
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Title or Position | COO/ADMINISTRATOR
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Name | MARQUITA YASHICA JOHNSON
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Credential |
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Telephone | 470-307-7358
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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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