Healthcare Provider Details

I. General information

NPI: 1811912249
Provider Name (Legal Business Name): CENTRAL GEORGIA HOMECARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 1ST STREET STE 100
MACON GA
31201-8395
US

IV. Provider business mailing address

800 1ST STREET STE 100
MACON GA
31201-8395
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-5700
  • Fax: 478-784-3574
Mailing address:
  • Phone: 478-633-5700
  • Fax: 478-784-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number20012623968
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHRE 008012
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHRE 008012
License Number StateGA

VIII. Authorized Official

Name: RHONDA S PERRY
Title or Position: EVP-CFO
Credential:
Phone: 478-633-1452