Healthcare Provider Details

I. General information

NPI: 1114666120
Provider Name (Legal Business Name): LIBERTY HOME HEALTH, LLC DBA CARELAB GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 N BERKELEY LAKE RD NW STE 1213
DULUTH GA
30096-1748
US

IV. Provider business mailing address

2730 N BERKELEY LAKE RD NW STE 1213
DULUTH GA
30096-1748
US

V. Phone/Fax

Practice location:
  • Phone: 678-557-4329
  • Fax:
Mailing address:
  • Phone: 678-557-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: TONY NGUYEN
Title or Position: MANAGER
Credential:
Phone: 404-510-5584