Healthcare Provider Details

I. General information

NPI: 1831052182
Provider Name (Legal Business Name): KOPH CARE INHOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PERIMETER PARK DR APT 555
ATLANTA GA
30341-1391
US

IV. Provider business mailing address

10 PERIMETER PARK DR APT 555
ATLANTA GA
30341-1391
US

V. Phone/Fax

Practice location:
  • Phone: 678-628-1871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NOVLETTE HANNAM
Title or Position: OWNER/FOUNDER
Credential:
Phone: 678-628-1871