Provider Demographics
NPI:1629468392
Name:A SUPERIOR CHOICE MEDICAL STAFFING LLC
Entity Type:Organization
Organization Name:A SUPERIOR CHOICE MEDICAL STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-464-1397
Mailing Address - Street 1:5881 GLENRIDGE DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5301
Mailing Address - Country:US
Mailing Address - Phone:404-257-1608
Mailing Address - Fax:404-257-1609
Practice Address - Street 1:5881 GLENRIDGE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5301
Practice Address - Country:US
Practice Address - Phone:404-257-1608
Practice Address - Fax:404-257-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-0154251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA413665791AMedicaid