Healthcare Provider Details

I. General information

NPI: 1689598450
Provider Name (Legal Business Name): HOME HEALTH SOURCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 OAK ST SW
ATLANTA GA
30310-1805
US

IV. Provider business mailing address

PO BOX 110101
ATLANTA GA
30311-0101
US

V. Phone/Fax

Practice location:
  • Phone: 404-808-2701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: BRIDGETTE JIMERSON
Title or Position: DIRECTOR
Credential:
Phone: 404-808-2701