=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174057194
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHCARE AT HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2017
-----------------------------------------------------
Last Update Date | 04/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5040 SNAPFINGER WOODS DR STE 104
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30035-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-777-7165
-----------------------------------------------------
Fax | 563-202-6972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5243 SNAPFINGER WOODS DR STE 104
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30035-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-777-7165
-----------------------------------------------------
Fax | 563-202-6972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | DR. TRICIA SALMON ANDERSON
-----------------------------------------------------
Credential | DNP, FNP-C
-----------------------------------------------------
Telephone | 678-777-7165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 195112
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------