Provider Demographics
NPI:1598133266
Name:THE JOHNICKIE GROUP
Entity Type:Organization
Organization Name:THE JOHNICKIE GROUP
Other - Org Name:JOHNICKIE SPAHOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:POMDREST
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-733-0141
Mailing Address - Street 1:5050 UNION ST UNIT 805
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2729
Mailing Address - Country:US
Mailing Address - Phone:404-810-1971
Mailing Address - Fax:404-420-2744
Practice Address - Street 1:5050 UNION ST UNIT 805
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2729
Practice Address - Country:US
Practice Address - Phone:678-733-0141
Practice Address - Fax:404-393-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No385H00000XRespite Care FacilityRespite Care