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General NPI Number Information
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NPI Number | 1306430467
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Entity Type | Organization
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Legal Business Name | SURESTICK LAB & HYDRATION SERVICES
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 101 BECKETT LN STE 505
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7160
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Country | US
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Telephone | 470-729-0166
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Fax |
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Provider Business Mailing Address
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Address Line | 10809 LEES CT
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City | JONESBORO
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State | GA
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Zip | 30238-7870
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Country | US
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Telephone | 708-692-4646
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Fax |
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Authorized Official
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Title or Position | RN/CEO
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Name | MELINDA HARRIS
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Credential | RN
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Telephone | 708-692-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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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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