Healthcare Provider Details

I. General information

NPI: 1306465075
Provider Name (Legal Business Name): KMS PRIVATE HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 PACES FERRY RD SE STE 750
ATLANTA GA
30339-4053
US

IV. Provider business mailing address

1205 JOSLIN PATH
DOUGLASVILLE GA
30134-3732
US

V. Phone/Fax

Practice location:
  • Phone: 678-368-2745
  • Fax:
Mailing address:
  • Phone: 470-471-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: KEESHA M MCCLOUD
Title or Position: OWNER/ADMIN
Credential:
Phone: 470-471-2821