=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861043705
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J. OLSON HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2019
-----------------------------------------------------
Last Update Date | 09/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12600 DEERFIELD PKWY STE 100
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30004-6130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-973-1907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3105 ABBEY DR SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30331-5477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-431-5483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PRISCELLA GRANT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-431-5483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------