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General NPI Number Information
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NPI Number | 1487009437
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Entity Type | Organization
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Legal Business Name | PRESITGE MANAGEMENT GROUP LLC
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 15 LONG GLEN CT
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City | COLUMBIA
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State | SC
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Zip | 29229-7742
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Country | US
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Telephone | 404-580-2824
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Fax |
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Provider Business Mailing Address
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Address Line | 3702 MANIGAULT PL SE
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City | MABLETON
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State | GA
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Zip | 30126-2841
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEANAN GRANT
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Credential |
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Telephone | 404-580-2824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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