Healthcare Provider Details

I. General information

NPI: 1306304852
Provider Name (Legal Business Name): VILLAGE AT HOME OF GEORGIA PLLC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PEACHTREE RD NE STE 1200
ATLANTA GA
30326-3251
US

IV. Provider business mailing address

PO BOX 392966
PITTSBURGH PA
15261-6263
US

V. Phone/Fax

Practice location:
  • Phone: 678-508-6832
  • Fax: 470-387-1639
Mailing address:
  • Phone: 844-969-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REBECCA RAGER
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 844-969-0686