Organization
COMPREHENSIVE VINE HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. QUINTINA L MACAULEY NP (OWNER)
(404) 796-6511
Entity
Organization
Contact information
Practice address
1978 SCARBROUGH DR, STONE MOUNTAIN, GA 30088-4422
(404) 796-6511
(678) 550-9140
Mailing address
1978 SCARBROUGH DR, STONE MOUNTAIN, GA 30088-4422
(404) 796-6511
(678) 550-9140
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
RN10908
GA
253Z00000X
In Home Supportive Care Agency
RN109088
GA
Other
Enumeration date
12/26/2011
Last updated
05/12/2023
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