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General NPI Number Information
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NPI Number | 1982074407
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Entity Type | Organization
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Legal Business Name | PHEMADEX HEALTHCARE SERVICES INC
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Dates
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Enumeration Date | 09/26/2015
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Last Update Date | 09/26/2015
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Provider Practice Location Address
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Address Line | 830 ASHLAND PARK WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-6808
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Country | US
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Telephone | 770-843-5897
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Fax | 770-544-7074
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Provider Business Mailing Address
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Address Line | 830 ASHLAND PARK WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-6808
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Country | US
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Telephone | 770-843-5897
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Fax | 770-544-7074
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. OLUFEMI ADEYEMO
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Credential |
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Telephone | 770-843-5897
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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 | 067R1324
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License Number State | GA
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