Healthcare Provider Details

I. General information

NPI: 1073439543
Provider Name (Legal Business Name): INDEPENDENCE AT HOME GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3293 STONE MOUNTAIN HWY STE G-28
SNELLVILLE GA
30078-6856
US

IV. Provider business mailing address

3293 STONE MOUNTAIN HWY STE G-28
SNELLVILLE GA
30078-6856
US

V. Phone/Fax

Practice location:
  • Phone: 215-764-9676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIANNA DUKES
Title or Position: CEO
Credential:
Phone: 215-764-9676