MEDICARE: A VISITING ANGELS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1245691468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A VISITING ANGELS, INC.

Provider Business Mailing Address
First Line	:	1075 PEACHTREE ST NE STE 3650
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3934
Country	:	US
Telephone Number	:	678-941-8122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 PEACHTREE ST NE STE 3650
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3934
Country	:	US
Telephone Number	:	678-941-8122
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	NICOLAS GBEDEMAKOU
Credential	:
Telephone Number	:	678-941-8122

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	03/15/2016

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