MEDICARE: AFFINIS HOSPICE, 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	251G00000X	Community Based Hospice Care Agency	008-0287-H	GA

General Provider Information

NPI Number	:	1669663506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINIS HOSPICE, LLC

Provider Business Mailing Address
First Line	:	806 MAPLE DR
Second Line	:	SUITE 804
City	:	VIDALIA
State	:	GA
Zip	:	30474-7208
Country	:	US
Telephone Number	:	912-538-8000
Fax Number	:	912-538-0467

Provider Business Practice Location Address
First Line	:	162 W MAIN ST STE 104
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-3573
Country	:	US
Telephone Number	:	678-689-2343
Fax Number	:	678-689-2345

Authorized Official
Title or Position	:	VICE PRESIDENT OF OPERATIONS
Name	:	MRS. SARAH A THOMPSON
Credential	:	RN, CHPN
Telephone Number	:	912-538-8000

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	11/03/2023

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