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General NPI Number Information
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NPI Number | 1831845635
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Entity Type | Organization
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Legal Business Name | GEORGIA ESSENTIAL PRIVATE CARE LLC
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 100 VICTORIAN WAY
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City | QUITMAN
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State | GA
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Zip | 31643-1476
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Country | US
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Telephone | 404-590-8872
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Fax |
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Provider Business Mailing Address
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Address Line | 100 VICTORIAN WAY
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City | QUITMAN
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State | GA
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Zip | 31643-1476
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Country | US
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Telephone | 404-590-8872
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MRS. TANISHA MOBLEY
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Credential |
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Telephone | 404-590-8872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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