Healthcare Provider Details

I. General information

NPI: 1588582407
Provider Name (Legal Business Name): NEW VILLAGE CARE GROUP,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 LAKEBOAT WAY SW
ATLANTA GA
30331-8936
US

IV. Provider business mailing address

1355 LAKEBOAT WAY SW
ATLANTA GA
30331-8936
US

V. Phone/Fax

Practice location:
  • Phone: 770-940-6797
  • Fax:
Mailing address:
  • Phone: 770-940-6797
  • 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: MRS. WANDA CRAIG
Title or Position: CEO
Credential:
Phone: 770-940-6797