Healthcare Provider Details

I. General information

NPI: 1104493550
Provider Name (Legal Business Name): FAMILY HEALTHCARE OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 LENOX RD NE STE 1000
ATLANTA GA
30326-2000
US

IV. Provider business mailing address

3355 LENOX RD NE STE 1000
ATLANTA GA
30326-2000
US

V. Phone/Fax

Practice location:
  • Phone: 678-679-7244
  • Fax:
Mailing address:
  • Phone: 678-679-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. DWAYNE LATTIMORE
Title or Position: CEO
Credential:
Phone: 470-530-6979