NPIMap

Organization Active NPI

Premier Personal Health Services, LLC

  • Home Health Agency
  • Palmetto, GA
National Provider Identifier
1205100591
Registry record updated Aug 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PREMIER PERSONAL HEALTH SERVICES, LLC
Practice address
8025 Wilkerson LN
Palmetto, GA 30268-8626
Phone
(404) 819-9665
Fax
(678) 624-6030
NPI assigned
Mar 4, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Lisa Yvonne Bradshaw-Small, APRN-BCNPI 1043330301
Title
Ceo
Phone
(404) 819-9665

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Nursing Care Agency 251J00000X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

8025 Wilkerson LN
Palmetto, GA 30268-8626

Mailing address

6269 Greenock Dr
Stone Mountain, GA 30087-6081
Phone (404) 819-9665

Other identifiers 1

IdentifierTypeStateIssuer
003112727AMedicaidGA

Other names 1

  • PREMIER CLA Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Premier Personal Health Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344729600000",
    "number": "1205100591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6269 GREENOCK DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876081",
            "telephone_number": "404-819-9665",
            "fax_number": "866-624-6594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8025 WILKERSON LN",
            "city": "PALMETTO",
            "state": "GA",
            "postal_code": "302688626",
            "telephone_number": "404-819-9665",
            "fax_number": "678-624-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PERSONAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-04",
        "last_updated": "2012-08-12",
        "status": "A",
        "authorized_official_last_name": "BRADSHAW-SMALL",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-819-9665",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN-BC"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003112727A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREMIER CLA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmetto, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.