Healthcare Provider Details

I. General information

NPI: 1669300851
Provider Name (Legal Business Name): SIRIUS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5761 DEERFIELD TRL
COLLEGE PARK GA
30349-3763
US

IV. Provider business mailing address

5761 DEERFIELD TRL
COLLEGE PARK GA
30349-3763
US

V. Phone/Fax

Practice location:
  • Phone: 404-478-7890
  • Fax: 202-989-0530
Mailing address:
  • Phone: 404-478-7890
  • Fax: 202-989-0530

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: SHAKEYA FRAZIER
Title or Position: AUTHORIZED AGENT / OWNER
Credential:
Phone: 678-799-1205