Healthcare Provider Details

I. General information

NPI: 1194695767
Provider Name (Legal Business Name): LIVING GRACEFULLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 HEPBURN DR
ATLANTA GA
30349-1031
US

IV. Provider business mailing address

317 HEPBURN DR
ATLANTA GA
30349-1031
US

V. Phone/Fax

Practice location:
  • Phone: 407-963-6144
  • Fax:
Mailing address:
  • Phone: 407-963-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIZZY REMY GEDNAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-963-6144