Healthcare Provider Details

I. General information

NPI: 1043125214
Provider Name (Legal Business Name): PODARIS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 NW 5TH WAY STE 1410A
FORT LAUDERDALE FL
33309-6131
US

IV. Provider business mailing address

6301 NW 5TH WAY STE 1410A
FORT LAUDERDALE FL
33309-6131
US

V. Phone/Fax

Practice location:
  • Phone: 888-551-7713
  • Fax:
Mailing address:
  • Phone: 888-551-7713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: AUBREY LYNN CHISUM
Title or Position: SVP OF OPERATIONS
Credential: PHARMD
Phone: 843-941-5220