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General NPI Number Information
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NPI Number | 1346476777
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Entity Type | Organization
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Legal Business Name | KORMICK HOME CARE
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Dates
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Enumeration Date | 05/29/2009
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 11380 SOUTHBRIDGE PKWY SUITE 225
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City | ALPHARETTA
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State | GA
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Zip | 30022-4433
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Country | US
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Telephone | 770-777-4781
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Fax | 770-777-4782
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Provider Business Mailing Address
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Address Line | 11380 SOUTHBRIDGE PKWY SUITE 225
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City | ALPHARETTA
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State | GA
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Zip | 30022-4433
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Country | US
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Telephone | 770-777-4781
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Fax | 770-777-4782
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUE P MCCORMICK
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Credential |
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Telephone | 770-777-4781
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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-0508
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License Number State | GA
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