Healthcare Provider Details

I. General information

NPI: 1336490283
Provider Name (Legal Business Name): QUALICARE OF GEORGIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 GREYTHORNE CMNS
DOUGLASVILLE GA
30135-8103
US

IV. Provider business mailing address

1755 THE EXCHANGE SE SUITE 210
ATLANTA GA
30339-7400
US

V. Phone/Fax

Practice location:
  • Phone: 404-819-4992
  • Fax:
Mailing address:
  • Phone: 678-508-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number060-R-1079
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number060-R-1079
License Number StateGA

VIII. Authorized Official

Name: MR. FRED J UMUNNAKWE
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 404-819-4992