Healthcare Provider Details

I. General information

NPI: 1992461610
Provider Name (Legal Business Name): ELITE CAREGIVERS OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ARROWHEAD DR
DALLAS GA
30132-9465
US

IV. Provider business mailing address

204 ARROWHEAD DR
DALLAS GA
30132-9465
US

V. Phone/Fax

Practice location:
  • Phone: 470-838-8501
  • Fax: 833-834-5444
Mailing address:
  • Phone: 470-838-8501
  • Fax: 833-834-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing 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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. APRIL POLITE
Title or Position: CLINICAL/LAB DIRECTOR
Credential:
Phone: 470-838-8501