Provider Demographics
NPI:1922688530
Name:SOUTHBRIDGE HOUSECALLS LLC
Entity Type:Organization
Organization Name:SOUTHBRIDGE HOUSECALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:404-542-5017
Mailing Address - Street 1:7870 WATERLACE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4647
Mailing Address - Country:US
Mailing Address - Phone:404-542-5017
Mailing Address - Fax:
Practice Address - Street 1:7870 WATERLACE DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4647
Practice Address - Country:US
Practice Address - Phone:404-542-5017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty