Provider Demographics
NPI:1720621592
Name:BILLUPS, FLOYD
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:
Last Name:BILLUPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SUNLIGHT CT
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4585
Mailing Address - Country:US
Mailing Address - Phone:708-256-0698
Mailing Address - Fax:
Practice Address - Street 1:5637 LA FLEUR TRL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2846
Practice Address - Country:US
Practice Address - Phone:708-256-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GABL19-000371OtherBUSINESS LICENSE