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General NPI Number Information
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NPI Number | 1720618077
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTHCARE OF GEORGIA
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 6509 BENNINGTON BLUFF CT
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City | MABLETON
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State | GA
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Zip | 30126-7269
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Country | US
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Telephone | 404-408-8703
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Fax |
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Provider Business Mailing Address
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Address Line | 6509 BENNINGTON BLUFF CT
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City | MABLETON
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State | GA
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Zip | 30126-7269
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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 | ADMINISTRATOR
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Name | NEIYA SPELLER
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Credential |
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Telephone | 631-678-6889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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