Provider Demographics
NPI:1356712830
Name:PROFESSIONAL MEDICAL INSTITUTE INC DBA PROFESSIONAL MEDICAL HOME CARE
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL INSTITUTE INC DBA PROFESSIONAL MEDICAL HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALVALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS HURSEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTEREDE NURSE
Authorized Official - Phone:404-464-5360
Mailing Address - Street 1:4336 COVINGTON HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1211
Mailing Address - Country:US
Mailing Address - Phone:404-289-7178
Mailing Address - Fax:404-289-7178
Practice Address - Street 1:4336 COVINGTON HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1211
Practice Address - Country:US
Practice Address - Phone:404-289-7178
Practice Address - Fax:404-289-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-1097253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care