Petlin Diversified Services LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

RN155427NP Issued in GA

Legal business name

PETLIN DIVERSIFIED SERVICES LLC

Practice address

2817 Lost Lakes Way
Powder Springs, GA 30127-6018

Phone

(770) 595-8934

NPI assigned

Jun 13, 2008

Last updated

Jun 13, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Linda Angela Mbah, NPNPI 1619165511

Title

Ceo

Phone

(770) 595-8934

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Linda Angela Mbah, MD

  • Family Medicine Physician
  • Jackson, MS
  • NPI 1619165511
  NPD (past) Authorized official

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

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1801056791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 LOST LAKES WAY",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301276018",
            "telephone_number": "770-595-8934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 LOST LAKES WAY",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301276018",
            "telephone_number": "770-595-8934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETLIN DIVERSIFIED SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-13",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "MBAH",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "ANGELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-595-8934",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "RN155427NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peach State Mobility LLC (Peachstate medical transport)
• Ashley Pearce, ATC, LAT
• Jeffrey Gordon Peeples, LPC
• Emilie Perry
• Naquiesha Peterson
• Phillip Medical Supplies
• Physician Acquisition Solutions, LLC
• Latoya Icelle Poole, PCT
• Trevino Pope
• Powder Springs Dentistry for Kids, LLC

• Skilled Nursing Facility in Powder Springs, GA
• Providers in Powder Springs, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.