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General NPI Number Information
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NPI Number | 1598133266
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Entity Type | Organization
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Legal Business Name | THE JOHNICKIE GROUP
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 5050 UNION ST UNIT 805
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City | UNION CITY
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State | GA
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Zip | 30291-2729
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Country | US
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Telephone | 678-733-0141
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Fax | 404-393-2101
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Provider Business Mailing Address
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Address Line | 5050 UNION ST UNIT 805
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City | UNION CITY
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State | GA
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Zip | 30291-2729
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Country | US
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Telephone | 404-810-1971
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Fax | 404-420-2744
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Authorized Official
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Title or Position | OWNER
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Name | MRS. POMDREST J HENRY
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Credential |
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Telephone | 678-733-0141
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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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 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 #4
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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