Provider Demographics
NPI:1891233474
Name:SOUTHERN COMPANIONS, LLC
Entity type:Organization
Organization Name:SOUTHERN COMPANIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNERS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:678-971-4147
Mailing Address - Street 1:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-1082
Mailing Address - Country:US
Mailing Address - Phone:678-971-4147
Mailing Address - Fax:770-825-9221
Practice Address - Street 1:623 GREEN ST NW
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3381
Practice Address - Country:US
Practice Address - Phone:678-971-4147
Practice Address - Fax:770-825-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069-R-0635253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care