Healthcare Provider Details

I. General information

NPI: 1992966790
Provider Name (Legal Business Name): AMERICAN HOME CARE & MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 MULBERRY ST
MACON GA
31201-6756
US

IV. Provider business mailing address

841 MULBERRY ST
MACON GA
31201-6756
US

V. Phone/Fax

Practice location:
  • Phone: 478-787-6040
  • Fax: 478-787-6039
Mailing address:
  • Phone: 478-787-6040
  • Fax: 478-787-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number011R0376
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number011R0376
License Number StateGA

VIII. Authorized Official

Name: TED OHANAJA
Title or Position: AGENCY ADMINISTRATOR
Credential:
Phone: 478-787-6040