Healthcare Provider Details

I. General information

NPI: 1053668392
Provider Name (Legal Business Name): SMARTWAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6927 HARBOR TOWN WAY
STONE MOUNTAIN GA
30087-5468
US

IV. Provider business mailing address

6927 HARBOR TOWN WAY
STONE MOUNTAIN GA
30087-5468
US

V. Phone/Fax

Practice location:
  • Phone: 404-447-5159
  • Fax:
Mailing address:
  • Phone: 404-447-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. BEVETTA MORTON
Title or Position: PRINCIPAL
Credential:
Phone: 404-447-5159