Provider Demographics
NPI:1932717618
Name:SOVEREIGN AND GRACE SERVICES
Entity Type:Organization
Organization Name:SOVEREIGN AND GRACE SERVICES
Other - Org Name:A.R.K DIAGNOSTICS SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FINANCIAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KULUVANDA
Authorized Official - Middle Name:QUARLETTE
Authorized Official - Last Name:CASON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:229-236-2585
Mailing Address - Street 1:241 POINT RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-0940
Mailing Address - Country:US
Mailing Address - Phone:229-403-5252
Mailing Address - Fax:229-226-6170
Practice Address - Street 1:551 SMITH AVE STE A
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5657
Practice Address - Country:US
Practice Address - Phone:229-236-2585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)