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Organization
REHOBOTH MIRACLE LLC
Active
Organization
REHOBOTH MIRACLE LLC
Active
Other names
Rehoboth Miracle Healthcare Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRAH OLIVE ANN RAMSAY COLL CERT IND REL (PRESIDENT)
(678) 712-6073
Entity
Organization
Contact information
Practice address
140 SHIVER BLVD, COVINGTON, GA 30016-1399
(678) 712-6073
Mailing address
140 SHIVER BLVD, COVINGTON, GA 30016-1399
(678) 712-6073
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
107 R 0894
GA
Other
Enumeration date
08/04/2011
Last updated
08/04/2011
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