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General NPI Number Information
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NPI Number | 1902154693
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Entity Type | Organization
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Legal Business Name | ANGEL'S LANDING HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 1631 SMYRNA RD SW
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City | CONYERS
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State | GA
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Zip | 30094-6156
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Country | US
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Telephone | 770-922-6293
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Fax |
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Provider Business Mailing Address
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Address Line | 1631 SMYRNA RD SW
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City | CONYERS
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State | GA
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Zip | 30094-6156
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Country | US
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Telephone | 404-645-0164
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MRS. CIDIA ALYSIA AWYIE
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Credential |
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Telephone | 404-989-9171
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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 | 122-R-1058
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License Number State | GA
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