Healthcare Provider Details

I. General information

NPI: 1053121590
Provider Name (Legal Business Name): FIDELIS INFUSIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 SNOW BIRD DR
HAMPTON GA
30228-3530
US

IV. Provider business mailing address

2015 JONESBORO RD # 190
MCDONOUGH GA
30253-5971
US

V. Phone/Fax

Practice location:
  • Phone: 678-469-3718
  • Fax:
Mailing address:
  • Phone: 678-469-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. KEISHA N FORD
Title or Position: OWNER
Credential:
Phone: 678-469-3718