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General NPI Number Information
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NPI Number | 1669029518
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Entity Type | Organization
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Legal Business Name | GEORGIA PREMIUM PERSONAL CARE
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 2107 GARDEN WOOD CT
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City | ATLANTA
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State | GA
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Zip | 30349-6290
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Country | US
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Telephone | 404-863-1541
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Fax |
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Provider Business Mailing Address
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Address Line | 2107 GARDEN WOOD CT
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City | ATLANTA
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State | GA
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Zip | 30349-6290
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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 | MRS. JACQUELINE JOHNSON
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Credential |
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Telephone | 404-857-8639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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