Healthcare Provider Details

I. General information

NPI: 1851080477
Provider Name (Legal Business Name): FIDELIS HEALTHCARE PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12461 VETERANS MEMORIAL HWY STE 837
DOUGLASVILLE GA
30134-2025
US

IV. Provider business mailing address

PO BOX 1916
VILLA RICA GA
30180-6429
US

V. Phone/Fax

Practice location:
  • Phone: 770-722-2034
  • Fax:
Mailing address:
  • Phone: 678-596-3361
  • Fax:

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: KISSIAH D DUPLESSIS
Title or Position: OWNER
Credential:
Phone: 678-596-3361