MEDICARE: CHARLIE'S NURSING ANGELS, LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1295487031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLIE'S NURSING ANGELS, LLC

Provider Business Mailing Address
First Line	:	712 AVONDALE HILLS DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-5829
Country	:	US
Telephone Number	:	404-709-2116
Fax Number	:

Provider Business Practice Location Address
First Line	:	2692 HARRIS ST STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-2672
Country	:	US
Telephone Number	:	404-709-2116
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLIE JOHNSON
Credential	:
Telephone Number	:	404-709-2116

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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