Healthcare Provider Details

I. General information

NPI: 1740405208
Provider Name (Legal Business Name): ATL-SOUTH HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 UPPER RIVERDALE RD SW SUITE D
RIVERDALE GA
30274-4945
US

IV. Provider business mailing address

253 UPPER RIVERDALE RD SW SUITE D
RIVERDALE GA
30274-4945
US

V. Phone/Fax

Practice location:
  • Phone: 770-907-2323
  • Fax: 770-907-2122
Mailing address:
  • Phone: 770-907-2323
  • Fax: 770-907-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2006-6055
License Number StateGA

VIII. Authorized Official

Name: EDDIE AMOAKUH
Title or Position: OWNER
Credential:
Phone: 770-907-2323