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NPI Code Detail

MEDICARE: THE 90 GROUP, LLC

MEDICARE: THE 90 GROUP, LLC
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
1251E00000XHome Health Agency110-R-1162GA

General Provider Information

NPI Number : 1841622925
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE 90 GROUP, LLC
Provider Business Mailing Address
First Line : 1800 PHOENIX BLVD BLDG 400
Second Line : SUITE 400 #16
City : COLLEGE PARK
State : GA
Zip : 30349
Country : US
Telephone Number : 770-790-0012
Fax Number : 866-205-6289
Provider Business Practice Location Address
First Line : 1800 PHOENIX BLVD STE 400
Second Line :
City : ATLANTA
State : GA
Zip : 30349-5560
Country : US
Telephone Number : 770-790-0012
Fax Number : 866-205-6289
Authorized Official
Title or Position : OWNER
Name : MS. MICHELE LEE ELLIS-WILLIAMS
Credential : QDCP
Telephone Number : 770-790-0012
Provider Enumeration Date : 07/31/2013
Last Update Date : 08/19/2019

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Directions to “THE 90 GROUP, LLC ” Practice Location

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