Provider Demographics
NPI:1083989669
Name:UNIQUE-N-ASSURANCE HEALTHCARE AGENCY LLC
Entity Type:Organization
Organization Name:UNIQUE-N-ASSURANCE HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-228-1422
Mailing Address - Street 1:PO BOX 2145
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-8909
Mailing Address - Country:US
Mailing Address - Phone:888-541-5552
Mailing Address - Fax:
Practice Address - Street 1:910 ARROWHEAD TRL # GA31088
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5372
Practice Address - Country:US
Practice Address - Phone:888-541-5552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076-R-1011302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization