Healthcare Provider Details

I. General information

NPI: 1780417360
Provider Name (Legal Business Name): CHAMPION HEALTHCARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 OLD ATLANTA RD
GRIFFIN GA
30223-1180
US

IV. Provider business mailing address

56 CLAYTON ENGLISH DR
FORSYTH GA
31029-9441
US

V. Phone/Fax

Practice location:
  • Phone: 404-955-9108
  • Fax: 770-914-1690
Mailing address:
  • Phone: 404-955-9108
  • Fax: 770-914-1690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LATOSHIA ZELLNER
Title or Position: OWNER
Credential:
Phone: 478-394-1623