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General NPI Number Information
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NPI Number | 1992016877
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Entity Type | Organization
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Legal Business Name | STG HEALTHCARE OF ATLANTA, INC
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 5555 GLENRIDGE CONNECTOR SUITE 750
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City | ATLANTA
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State | GA
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Zip | 30342-4759
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Country | US
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Telephone | 404-856-6110
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Fax | 404-252-7590
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Provider Business Mailing Address
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Address Line | 5555 GLENRIDGE CONNECTOR SUITE 750
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City | ATLANTA
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State | GA
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Zip | 30342-4759
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Country | US
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Telephone | 404-856-6110
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Fax | 404-252-7590
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Authorized Official
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Title or Position | CEO
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Name | MR. PASCAL GILLEY JR.
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Credential |
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Telephone | 404-843-2708
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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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