Healthcare Provider Details

I. General information

NPI: 1902181886
Provider Name (Legal Business Name): CIRCLE OF ANGELS HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 HIGHWAY 212 SW
CONYERS GA
30094-3350
US

IV. Provider business mailing address

2817 HIGHWAY 212 SW
CONYERS GA
30094-3350
US

V. Phone/Fax

Practice location:
  • Phone: 770-679-1899
  • Fax: 770-648-6060
Mailing address:
  • Phone: 770-679-1899
  • Fax: 770-648-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. MICHELLE DUNBAR
Title or Position: PRESIDENT
Credential: RN
Phone: 770-882-8401