# PROFESSIONAL NURSING AND SUPPORT SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** none
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134409519
- **Authorized official:** MRS. LASHANDA L WILLIAMS REGISTERED NURSE (ADMINISTRATOR)
- **Authorized official phone:** (229) 559-4607

## Contact information

- **Practice address:** 7626 ENOCH LAKE CIR, LAKE PARK, GA 31636-3906
- **Practice address phone:** (229) 559-4607
- **Mailing address:** 7626 ENOCH LAKE CIR, LAKE PARK, GA 31636-3906
- **Mailing address phone:** (229) 559-4607

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251J00000X | Nursing Care Agency | RN210699 | GA | — |
| 253Z00000X | In Home Supportive Care Agency | 092-R-0897 | GA | Yes |

## Other

- **Enumeration date:** 08/17/2011
- **Last updated:** 08/17/2011