=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851500276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMEDISYS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 INTERSTATE PARK DR SUITE 324
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36109-5427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-272-0313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 INTERSTATE PARK DR SUITE 324
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36109-5427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-272-0313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH THERAPIST
-----------------------------------------------------
Name | DAPHNE P DAWSON
-----------------------------------------------------
Credential | MCD,CCC-SLP
-----------------------------------------------------
Telephone | 334-272-0313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2295
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------