Golden Bloom Phrams INC
Exclusive Provider Organization in Conyers, GA. Organization (NPI-2).
NPI number1962007252
StatusActive
Last updated in NPPESDec 3, 2020
Details
- NPI
- 1962007252
- Entity type
- Organization (NPI-2)
- Legal business name
- Golden Bloom Phrams INC
- Organization subpart
- No
- Enumeration date
- Dec 3, 2020
- Certification date
- Dec 3, 2020
- Last updated
- Dec 3, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302F00000X | Exclusive Provider Organization | – | – | Yes |
Practice location
1172 Old Salem Rd SeConyers, GA 30094-5944
Phone 770-633-8550
Mailing address
1172 Old Salem Rd SeConyers, GA 30094-5944
Phone 770-633-8550
Authorized official
Jessica Lane
President
7706338550
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