Healthcare Provider Details

I. General information

NPI: 1447696786
Provider Name (Legal Business Name): ATHERIUM HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N BROWN RD SUITE 200
LAWRENCEVILLE GA
30043-8198
US

IV. Provider business mailing address

1755 N BROWN RD SUITE 200
LAWRENCEVILLE GA
30043-8198
US

V. Phone/Fax

Practice location:
  • Phone: 678-690-5296
  • Fax: 888-473-7096
Mailing address:
  • Phone: 678-690-5296
  • Fax: 888-473-7096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ERNESTO JUAN ANAYA
Title or Position: CEO
Credential: MBA
Phone: 678-690-5296