Healthcare Provider Details

I. General information

NPI: 1154030856
Provider Name (Legal Business Name): AFFINITY CARE OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 BUFORD HWY NE STE 285
ATLANTA GA
30324-5488
US

IV. Provider business mailing address

78 OPAL ST
CARTERSVILLE GA
30120-2848
US

V. Phone/Fax

Practice location:
  • Phone: 510-499-9977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL STERN
Title or Position: CEO
Credential:
Phone: 510-499-9977