Provider Demographics
NPI:1558979930
Name:PEARLS OF WISDOM HEALTHCARE LLC
Entity Type:Organization
Organization Name:PEARLS OF WISDOM HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-572-5873
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-8002
Mailing Address - Country:US
Mailing Address - Phone:770-572-5873
Mailing Address - Fax:404-999-2583
Practice Address - Street 1:600 GREENSFERRY AVE SW APT 903
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-4347
Practice Address - Country:US
Practice Address - Phone:770-572-5873
Practice Address - Fax:404-999-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care