=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932819588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOM SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2022
-----------------------------------------------------
Last Update Date | 12/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 DARBYS CROSSING DR STE 206G
-----------------------------------------------------
City | HIRAM
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30141-6028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-759-0759
-----------------------------------------------------
Fax | 770-759-0758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 477 CLEBURNE PL
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30101-1959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-759-0759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ORATHIA MITCHELL
-----------------------------------------------------
Credential | EDD
-----------------------------------------------------
Telephone | 770-759-0759
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------