| Comprehensive Vine Health Services | |
|
1978 Scarbrough Dr Stone Mountain GA 30088-4422 | |
| (404) 796-6511 | |
| (678) 550-9140 |
| Full Name | Comprehensive Vine Health Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1978 Scarbrough Dr, Stone Mountain, Georgia |
| Authorized Official Name and Position | Quintina L Macauley (OWNER) |
| Authorized Official Contact | 4047966511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Comprehensive Vine Health Services 1978 Scarbrough Dr Stone Mountain GA 30088-4422 Ph: (404) 796-6511 | Comprehensive Vine Health Services 1978 Scarbrough Dr Stone Mountain GA 30088-4422 Ph: (404) 796-6511 |
| NPI Number | 1972872661 |
|---|---|
| Provider Enumeration Date | 12/26/2011 |
| Last Update Date | 05/12/2023 |
| Certification Date | 05/12/2023 |
| Medicare PECOS PAC ID | 6507032893 |
|---|---|
| Medicare Enrollment ID | O20120109000650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972872661 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | RN10908 (Georgia) | Primary |
| 253Z00000X | In Home Supportive Care | RN109088 (Georgia) | Secondary |
| Provider Name | Lana M Chase |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1346441029 PECOS PAC ID: 1355232893 Enrollment ID: I20040323001282 |
| Provider Name | Quintina L Macauley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326352972 PECOS PAC ID: 7214103506 Enrollment ID: I20120109000678 |
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