Healthcare Provider Details

I. General information

NPI: 1518782325
Provider Name (Legal Business Name): THE COLOR OF EXCELLENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 WATERTON DR
LITHONIA GA
30058-3509
US

IV. Provider business mailing address

6124 WATERTON DR
LITHONIA GA
30058-3509
US

V. Phone/Fax

Practice location:
  • Phone: 937-304-8067
  • Fax:
Mailing address:
  • Phone: 678-338-0882
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LATORIA SHANTAE MARTIN
Title or Position: CEO
Credential: LNHA, BSN
Phone: 678-338-0882