Healthcare Provider Details

I. General information

NPI: 1780548966
Provider Name (Legal Business Name): FAMILY HOSPICE SOUTH ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 COUNTRY CLUB DR BLDG 300A
STOCKBRIDGE GA
30281-7388
US

IV. Provider business mailing address

175 COUNTRY CLUB DR BLDG 300A
STOCKBRIDGE GA
30281-7388
US

V. Phone/Fax

Practice location:
  • Phone: 800-410-4663
  • Fax:
Mailing address:
  • Phone: 800-410-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARLES HALL
Title or Position: CEO
Credential:
Phone: 800-410-4663