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General NPI Number Information
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NPI Number | 1790032712
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Entity Type | Organization
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Legal Business Name | LIBERTY AND ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 1945 FOSTER TRACE CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6545
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Country | US
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Telephone | 404-401-0266
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Fax | 770-338-7716
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Provider Business Mailing Address
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Address Line | 1945 FOSTER TRACE CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6545
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Country | US
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Telephone | 404-401-0266
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Fax | 770-338-7716
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | CHIBUEZE OKWARAOHA
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Credential | RN
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Telephone | 404-401-0266
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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 | RN208307
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | RN208307
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 067-R-0958
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License Number State | GA
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