Organization
PRIVATECARENURSINGSERVICELLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ATHENA TOLIVER (ADMINSTOR)
(386) 846-1793
Entity
Organization
Contact information
Practice address
3200 SUMMIT PLACE DR, LOGANVILLE, GA 30052-5334
(386) 846-1793
Mailing address
PO BOX 391812, SNELLVILLE, GA 30039-0031
(386) 846-1793
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
066307
GA
Other
Enumeration date
03/14/2014
Last updated
03/14/2014
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