Organization
PREVENTIVE & FITNESS HEALTHCARE AGENCY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WYLENE WORTHEN REGISTERED NURSE (ADMINISTRATOR/OWNER)
(478) 456-9438
Entity
Organization
Contact information
Practice address
1800 N RIDGE DR STE 1, MILLEDGEVILLE, GA 31061-2258
(478) 295-2955
(475) 295-3210
Mailing address
1800 N RIDGE DR STE 1, MILLEDGEVILLE, GA 31061-2258
(478) 295-2955
(475) 295-3210
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003232271A
—
GA
Enumeration date
01/02/2023
Last updated
01/02/2023
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