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General NPI Number Information
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NPI Number | 1821354630
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Entity Type | Organization
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Legal Business Name | PREMIER PERSONAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 6269 GREENOCK DR
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-6081
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Country | US
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Telephone | 866-446-4547
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Fax | 678-825-6030
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Provider Business Mailing Address
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Address Line | 6269 GREENOCK DR
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-6081
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Country | US
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Telephone | 866-446-4547
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Fax | 678-825-6030
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Authorized Official
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Title or Position | CEO
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Name | MRS. LISA YVONNE BRADSHAW-SMALL
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Credential | APRN, BC
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Telephone | 866-447-4547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral 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 | 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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Taxonomy #3
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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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