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General NPI Number Information
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NPI Number | 1447417639
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Entity Type | Organization
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Legal Business Name | SUNCREST HOME HEALTH OF GEORGIA, INC
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 2400 LAKE PARK DR SE STE 450
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City | SMYRNA
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State | GA
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Zip | 30080-7644
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Country | US
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Telephone | 770-429-1455
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Fax | 770-801-9529
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Provider Business Mailing Address
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Address Line | 9510 ORMSBY STATION RD STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40223-5016
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Country | US
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Telephone | 502-891-1000
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Fax | 502-891-1427
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSHUA L. PROFFITT
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Credential |
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Telephone | 337-233-1307
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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 | 033074
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License Number State | GA
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