MEDICARE: PREVENTIVE MEASURES OF GA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	170456LGB	GA

General Provider Information

NPI Number	:	1821453010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIVE MEASURES OF GA

Provider Business Mailing Address
First Line	:	1808 OVER LAKE DR SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6608
Country	:	US
Telephone Number	:	678-806-3468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 OVER LAKE DR SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6608
Country	:	US
Telephone Number	:	678-806-3468
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CFO
Name	:	ERIN HARRIS
Credential	:
Telephone Number	:	484-226-0986

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	10/03/2024

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