Healthcare Provider Details

I. General information

NPI: 1255139192
Provider Name (Legal Business Name): FIRST FRUITS LEGACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 RIVERSIDE PKWY SW STE 2P
AUSTELL GA
30168-7749
US

IV. Provider business mailing address

135 RIVERSIDE PKWY SW STE 2P
AUSTELL GA
30168-7749
US

V. Phone/Fax

Practice location:
  • Phone: 615-260-7688
  • Fax:
Mailing address:
  • Phone: 615-260-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIE HOGUE
Title or Position: ADMIN
Credential: DDS
Phone: 615-260-7688