Healthcare Provider Details

I. General information

NPI: 1679155824
Provider Name (Legal Business Name): COMPANION CARE OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 SE BROAD ST
METTER GA
30439-4428
US

IV. Provider business mailing address

58 SE BROAD ST
METTER GA
30439-4428
US

V. Phone/Fax

Practice location:
  • Phone: 912-685-4500
  • Fax: 912-685-4540
Mailing address:
  • Phone: 912-685-4500
  • Fax: 912-685-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN CHARLES TAYLOR JR.
Title or Position: OWNER
Credential:
Phone: 912-685-4500