Healthcare Provider Details

I. General information

NPI: 1104061159
Provider Name (Legal Business Name): AMEDISYS GEORGIA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 S COLLEGE ST
HAMILTON GA
31811-5306
US

IV. Provider business mailing address

5959 SOUTH SHERWOOD BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 706-628-4622
  • Fax: 706-628-9159
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number11243H
License Number StateGA

VIII. Authorized Official

Name: MR. WILLIAM BORNE
Title or Position: CEO
Credential:
Phone: 225-292-2031