Provider Demographics
NPI:1437278504
Name:PROFESSIONAL HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:OBIOFUMA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:404-286-4030
Mailing Address - Street 1:4319 COVINGTON HWY
Mailing Address - Street 2:SUITE 309B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1210
Mailing Address - Country:US
Mailing Address - Phone:404-286-4030
Mailing Address - Fax:404-286-1442
Practice Address - Street 1:4319 COVINGTON HWY
Practice Address - Street 2:SUITE 309B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1210
Practice Address - Country:US
Practice Address - Phone:404-286-4030
Practice Address - Fax:404-286-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-0069251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health