Healthcare Provider Details

I. General information

NPI: 1225681752
Provider Name (Legal Business Name): AGATE ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 02/11/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 FRASHER WAY
JOHNS CREEK GA
30097-2426
US

IV. Provider business mailing address

205 FRASHER WAY
JOHNS CREEK GA
30097-2426
US

V. Phone/Fax

Practice location:
  • Phone: 404-542-6180
  • Fax:
Mailing address:
  • Phone: 404-542-6180
  • Fax:

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ASAD ABBAS RIZVI
Title or Position: CEO
Credential:
Phone: 404-542-6180