Healthcare Provider Details

I. General information

NPI: 1902637382
Provider Name (Legal Business Name): A FAMILIAR FACE HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 WISTERIA DR UNIT 1643
SNELLVILLE GA
30078-4842
US

IV. Provider business mailing address

2440 WISTERIA DR
SNELLVILLE GA
30078-0337
US

V. Phone/Fax

Practice location:
  • Phone: 404-801-4101
  • Fax:
Mailing address:
  • Phone: 404-801-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: JORDEAN ANDERSON
Title or Position: OWNER
Credential:
Phone: 404-801-4101