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General NPI Number Information
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NPI Number | 1447144407
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Entity Type | Organization
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Legal Business Name | ATLANTA FOOT FAIRY LLC
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 4810 MOCKINGBIRD LN
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3616
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Country | US
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Telephone | 678-544-6179
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Fax |
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Provider Business Mailing Address
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Address Line | 4810 MOCKINGBIRD LN
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3616
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Country | US
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Telephone | 678-544-6179
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CLINICAL DIRECTOR
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Name | MS. CHANTELLE MORRISON-KOUROUMA
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Credential | BSN-RN
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Telephone | 678-544-6179
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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 | 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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