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General NPI Number Information
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NPI Number | 1689790867
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Entity Type | Organization
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Legal Business Name | MEDSIDE PALLIATIVE CARE
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 3384 PEACHTREE RD NE
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City | ATLANTA
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State | GA
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Zip | 30326-1181
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Country | US
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Telephone | 404-633-7433
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Fax | 888-633-7430
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Provider Business Mailing Address
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Address Line | PO BOX 190996
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City | ATLANTA
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State | GA
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Zip | 31119-0996
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Country | US
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Telephone | 404-633-7433
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Fax | 888-633-7430
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Authorized Official
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Title or Position | CHA/ADMINISTRATOR
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Name | MS. YULIYA KORABELNIKOVA
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Credential | RN
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Telephone | 404-633-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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