Provider Demographics
NPI:1649302654
Name:UNIVERSAL HEALTH CARE AND PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:UNIVERSAL HEALTH CARE AND PROFESSIONAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-489-5006
Mailing Address - Street 1:8311 OFFICE PARK DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6935
Mailing Address - Country:US
Mailing Address - Phone:770-489-5006
Mailing Address - Fax:770-489-5011
Practice Address - Street 1:8325 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6936
Practice Address - Country:US
Practice Address - Phone:770-489-5006
Practice Address - Fax:770-489-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5884060001Medicare NSC