Provider Demographics
NPI:1790054369
Name:PROFESSIONAL NURSING SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL NURSING SERVICES
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANIECE
Authorized Official - Middle Name:EYVETTE
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-368-8655
Mailing Address - Street 1:7136 WOODSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-9000
Mailing Address - Country:US
Mailing Address - Phone:678-368-8655
Mailing Address - Fax:
Practice Address - Street 1:7136 WOODSTONE DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-9000
Practice Address - Country:US
Practice Address - Phone:678-368-8655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00228363302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization