Healthcare Provider Details

I. General information

NPI: 1235090929
Provider Name (Legal Business Name): NORTH GEORGIA HOSPICE AND PALLIATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 PROMINENCE CT STE 150
DAWSONVILLE GA
30534-8940
US

IV. Provider business mailing address

139 PROMINENCE CT STE 150
DAWSONVILLE GA
30534-8940
US

V. Phone/Fax

Practice location:
  • Phone: 678-316-0288
  • Fax: 770-676-7087
Mailing address:
  • Phone: 678-316-0288
  • Fax: 770-676-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE RICHARDSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 470-909-7318