Premier Comprehensive Services, Llc | |
2001 Martin Luther King Jr Dr Sw Atlanta GA 30310-1101 | |
(678) 316-6997 | |
(678) 903-4190 |
Full Name | Premier Comprehensive Services, Llc |
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Speciality | Counselor |
Location | 2001 Martin Luther King Jr Dr Sw, Atlanta, Georgia |
Authorized Official Name and Position | Avery Mitchell (OWNER/DIRECTOR) |
Authorized Official Contact | 6783166997 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Premier Comprehensive Services, Llc 4910 Eagles Valley Cir Lithonia GA 30038-3552 Ph: (678) 316-6997 | Premier Comprehensive Services, Llc 2001 Martin Luther King Jr Dr Sw Atlanta GA 30310-1101 Ph: (678) 316-6997 |
NPI Number | 1598373656 |
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Provider Enumeration Date | 07/15/2020 |
Last Update Date | 01/05/2024 |
Certification Date | 07/15/2020 |
Medicare PECOS PAC ID | 7719329820 |
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Medicare Enrollment ID | O20240521002429 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598373656 | NPI | - | NPPES |
003143597A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Avery Mitchell |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1760822746 PECOS PAC ID: 2264874379 Enrollment ID: I20240521002690 |
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