Healthcare Provider Details

I. General information

NPI: 1609634815
Provider Name (Legal Business Name): GEORGIA HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JOSEPH E BOONE BLVD NW
ATLANTA GA
30314-2032
US

IV. Provider business mailing address

4401 E INDEPENDENCE BLVD STE 200D
CHARLOTTE NC
28205-7485
US

V. Phone/Fax

Practice location:
  • Phone: 404-939-9965
  • Fax: 404-420-2250
Mailing address:
  • Phone: 704-275-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AHMAD BLAKENEY
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 704-201-8038