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General NPI Number Information
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NPI Number | 1336490283
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Entity Type | Organization
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Legal Business Name | QUALICARE OF GEORGIA, INC
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 2370 GREYTHORNE CMNS
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-8103
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Country | US
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Telephone | 404-819-4992
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Fax |
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Provider Business Mailing Address
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Address Line | 1755 THE EXCHANGE SE SUITE 210
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City | ATLANTA
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State | GA
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Zip | 30339-7400
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Country | US
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Telephone | 678-508-6146
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | MR. FRED J UMUNNAKWE
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Credential |
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Telephone | 404-819-4992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 060-R-1079
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 060-R-1079
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License Number State | GA
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