| 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 |
|---|---|
| Speciality | Community/Behavioral Health |
| 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 |
|---|---|
| Provider Enumeration Date | 07/15/2020 |
| Last Update Date | 02/10/2025 |
| Certification Date | 02/10/2025 |
| Medicare PECOS PAC ID | 7719329820 |
|---|---|
| Medicare Enrollment ID | O20240521002429 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598373656 | NPI | - | NPPES |
| 003143597A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Avery Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760822746 PECOS PAC ID: 2264874379 Enrollment ID: I20240521002690 |
| Provider Name | Edmonia Sianneh Doe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659902666 PECOS PAC ID: 9032648258 Enrollment ID: I20250131002935 |
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