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General NPI Number Information
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NPI Number | 1912517921
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Entity Type | Organization
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Legal Business Name | YOUR CARE AT HOME LLC
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 4132 ATLANTA HWY STE 110-199
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City | LOGANVILLE
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State | GA
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Zip | 30052-5285
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Country | US
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Telephone | 678-506-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 4132 ATLANTA HWY STE 110-199
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City | LOGANVILLE
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State | GA
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Zip | 30052-5285
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Country | US
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Telephone | 678-506-1778
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | COURTNEY B COOK
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Credential | NP
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Telephone | 678-506-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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