MEDICARE: CROWN SIGNATURE HOME CARE

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1427996172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN SIGNATURE HOME CARE

Provider Business Mailing Address
First Line	:	2086 JODECO RD # 1661
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-5220
Country	:	US
Telephone Number	:	770-609-9225
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 GRANDIFLORA DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-8009
Country	:	US
Telephone Number	:	770-609-9225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIARA JACKSON
Credential	:
Telephone Number	:	678-358-9243

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

Similar Medicare Providers

1780425843 — DR. AMANDA SIMONE ADAMS DDS
Practice Location Address:

1867 JONESBORO RD
MCDONOUGH, GA
30253-6099

Practice Phone: 678-432-0209
Practice Fax:

1619227576 — ICEESHO BETHEL RRT
Practice Location Address:

2086 JODECO RD # 1674
MCDONOUGH, GA
30253-5220

Practice Phone: 678-763-9797
Practice Fax:

1790623551 — ESSENTIAL CASE MANAGEMENT LLC
Practice Location Address:

180 WARBLER WAY
MCDONOUGH, GA
30253-7758

Practice Phone: 470-531-7510
Practice Fax:

1508945957 — ASHLEY BURIN DPT
Practice Location Address:

2168 HIGHWAY 20 W
MCDONOUGH, GA
30253-7205

Practice Phone: 470-944-7550
Practice Fax: 470-944-7551

1942900394 — JORDAN TAYLOR HARDIN NP
Practice Location Address:

1631 HIGHWAY 20 W
MCDONOUGH, GA
30253-7311

Practice Phone: 770-288-2822
Practice Fax:

1528628104 — MS. SHASHONDALYN SHANAY SAMUELS CM
Practice Location Address:

1944 BRANNAN RD
MCDONOUGH, GA
30253-4310

Practice Phone: 678-289-6981
Practice Fax:

Directions to “CROWN SIGNATURE HOME CARE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.