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General NPI Number Information
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NPI Number | 1467882795
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Entity Type | Organization
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Legal Business Name | HOMECARE MEDICINE OF ATLANTA LLC
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 3330 CUMBERLAND BLVD SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-5995
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Country | US
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Telephone | 770-740-2611
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Fax | 770-800-3100
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Provider Business Mailing Address
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Address Line | 3330 CUMBERLAND BLVD SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-5995
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | MARY NWOKE
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Credential |
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Telephone | 240-271-4480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 67534
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 68460
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License Number State | GA
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