Provider Demographics
NPI:1629509344
Name:EXCLUSIVE CONCIERGE SERVICES
Entity Type:Organization
Organization Name:EXCLUSIVE CONCIERGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINTHIANS
Authorized Official - Middle Name:DEQUINDRAE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-615-8060
Mailing Address - Street 1:6 SOUTHSIDE CT APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-4428
Mailing Address - Country:US
Mailing Address - Phone:706-615-8060
Mailing Address - Fax:706-610-0910
Practice Address - Street 1:6 SOUTHSIDE CT APT B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903-4428
Practice Address - Country:US
Practice Address - Phone:706-615-8060
Practice Address - Fax:706-610-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055473103347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1639594302Medicare PIN