MEDICARE: CARESOUTH HHA HOLDINGS OF MIDDLE GEORGIA, 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		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011-269-H	OTHER	GA	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	11D1093954	OTHER	GA	CLIA

General Provider Information

NPI Number	:	1972762599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESOUTH HHA HOLDINGS OF MIDDLE GEORGIA, LLC

Provider Business Mailing Address
First Line	:	6688 N CENTRAL EXPRESSWAY
Second Line	:	SUITE 1300
City	:	DALLAS
State	:	TX
Zip	:	75206-3950
Country	:	US
Telephone Number	:	214-239-6500
Fax Number	:	214-239-6581

Provider Business Practice Location Address
First Line	:	3920 ARKWRIGHT RD STE 325
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31210-1731
Country	:	US
Telephone Number	:	478-742-7557
Fax Number	:	478-742-8491

Authorized Official
Title or Position	:	EVP OF HOME HEALTH OPERATIONS
Name	:	JULIE DIANE JOLLEY
Credential	:
Telephone Number	:	214-239-6500

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	12/31/2024

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