NPI 1962007252

Golden Bloom Phrams INC

Organisation Exclusive Provider Organization Conyers, GA

Practice location

Address: 1172 Old Salem Rd SE, Conyers, GA 30094-5944
Phone: (770) 633-8550

Authorised official

Name: Jessica Lane
Title: President
Phone: (770) 633-8550

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

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Registry record

NPI: 1962007252
Entity type: Organization
NPI issued: 3 Dec 2020
Record last updated: 3 Dec 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.