Healthcare Provider Details

I. General information

NPI: 1578477659
Provider Name (Legal Business Name): ELVIS ERHENEDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KWASI BAIDOO

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 HARVEST WALK
MACON GA
31210-5514
US

IV. Provider business mailing address

326 HARVEST WALK
MACON GA
31210-5514
US

V. Phone/Fax

Practice location:
  • Phone: 478-508-1333
  • Fax:
Mailing address:
  • Phone: 478-508-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number374U00000X
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: