Provider Demographics
NPI:1508031527
Name:PROFESSIONAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:WHELCHEL
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-536-5700
Mailing Address - Street 1:977 ENOTA AVE NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1700
Mailing Address - Country:US
Mailing Address - Phone:770-536-5700
Mailing Address - Fax:
Practice Address - Street 1:977 ENOTA AVE NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1700
Practice Address - Country:US
Practice Address - Phone:770-536-5700
Practice Address - Fax:770-535-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069-R-0004251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care