MEDICARE: PROACTIVE TOTAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	146L00000X	Paramedic
2	251B00000X	Case Management Agency
3	251J00000X	Nursing Care Agency
4	253Z00000X	In Home Supportive Care Agency
5	302R00000X	Health Maintenance Organization
6	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1851259501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE TOTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	5833 HILL RD
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-4042
Country	:	US
Telephone Number	:	770-842-5775
Fax Number	:

Provider Business Practice Location Address
First Line	:	5833 HILL RD
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-4042
Country	:	US
Telephone Number	:	770-842-5775
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICHOLLE BROCK
Credential	:	PARAMEDIC
Telephone Number	:	770-842-5775

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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