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General NPI Number Information
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NPI Number | 1225068612
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Entity Type | Organization
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Legal Business Name | HOME HEALTH AGENCY OF GEORGIA LLC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 1705 ENTERPRISE WAY SE SUITE 102
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City | MARIETTA
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State | GA
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Zip | 30067-9224
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Country | US
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Telephone | 678-354-1456
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Fax | 678-797-5761
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Provider Business Mailing Address
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Address Line | PO BOX 1956
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City | HATTIESBURG
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State | MS
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Zip | 39403-1956
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Country | US
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Telephone | 601-544-2900
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Fax | 601-264-3512
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILFORD A. PAYNE III
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Credential |
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Telephone | 601-544-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | GA
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