Organization
DIVINE 5 SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELANTE HARRIS (CEO)
(770) 217-1821
Entity
Organization
Contact information
Practice address
304 E CHURCH ST, MONROE, GA 30655-2508
(770) 217-1821
Mailing address
304 E CHURCH ST, MONROE, GA 30655-2508
(770) 217-1821
Taxonomy
Speciality
Code
Description
License number
State
347E00000X
Transportation Broker
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
824625122
NON-MEDICAL
GA
Enumeration date
04/24/2018
Last updated
06/11/2019
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