MEDICARE: SBSW MATERNAL SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	253Z00000X	In Home Supportive Care Agency
3	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1184568941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SBSW MATERNAL SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	24 BLACKGUM TRCE
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-5472
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 BLACKGUM TRCE
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-5472
Country	:	US
Telephone Number	:	229-444-2583
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARMINA LEWIS
Credential	:	RN
Telephone Number	:	229-444-2583

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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