MEDICARE: PATHMEDIC 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	122-R-0608	GA

General Provider Information

NPI Number	:	1740517416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHMEDIC LLC

Provider Business Mailing Address
First Line	:	903 HONEY CREEK RD SE # B
Second Line	:	SUITE 275
City	:	CONYERS
State	:	GA
Zip	:	30094-2801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 GEES MILL RD NE
Second Line	:	SUITE 326
City	:	CONYERS
State	:	GA
Zip	:	30013-1362
Country	:	US
Telephone Number	:	770-679-9348
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ROSELYNE O LOVELACE
Credential	:
Telephone Number	:	770-679-9348

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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Directions to “PATHMEDIC LLC ” Practice Location

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