Healthcare Provider Details

I. General information

NPI: 1831962216
Provider Name (Legal Business Name): GREEN CANARY HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6470 E JOHNS XING STE 160
JOHNS CREEK GA
30097-1500
US

IV. Provider business mailing address

6470 E JOHNS XING STE 160
JOHNS CREEK GA
30097-1500
US

V. Phone/Fax

Practice location:
  • Phone: 404-528-0297
  • Fax:
Mailing address:
  • Phone:
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: SHANTEL TATUM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 404-528-0297