Provider Demographics
NPI:1699440016
Name:PERIDOT AND EMERALD MOBILE SERVICES, LLC
Entity type:Organization
Organization Name:PERIDOT AND EMERALD MOBILE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:470-545-0860
Mailing Address - Street 1:2890 GEORGIA HIGHWAY 212 SW STE A106
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3363
Mailing Address - Country:US
Mailing Address - Phone:470-545-0860
Mailing Address - Fax:470-300-7778
Practice Address - Street 1:1315 MILSTEAD RD NE STE 101
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3824
Practice Address - Country:US
Practice Address - Phone:470-545-0860
Practice Address - Fax:470-300-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty