Provider Demographics
NPI:1699733279
Name:ME AND MY NANNA, LLC
Entity type:Organization
Organization Name:ME AND MY NANNA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-471-5338
Mailing Address - Street 1:5878 BUFORD HWY., STE. 9
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1245
Mailing Address - Country:US
Mailing Address - Phone:678-381-1540
Mailing Address - Fax:877-496-4822
Practice Address - Street 1:5878 BUFORD HWY.,
Practice Address - Street 2:STE. 9
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-1245
Practice Address - Country:US
Practice Address - Phone:678-381-1540
Practice Address - Fax:877-496-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060R0147251E00000X
GA060-R-0147251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA341641551EMedicaid
GA341641551BMedicaid