MEDICARE: FAMILY BRIDGE INTERNATIONAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	031-R-0035	GA

General Provider Information

NPI Number	:	1013938612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY BRIDGE INTERNATIONAL INC

Provider Business Mailing Address
First Line	:	515 MUNDYS MILL RD
Second Line	:	SUITE A
City	:	JONESBORO
State	:	GA
Zip	:	30238-5945
Country	:	US
Telephone Number	:	770-231-7661
Fax Number	:	770-210-8497

Provider Business Practice Location Address
First Line	:	515 MUNDYS MILL RD
Second Line	:	SUITE A
City	:	JONESBORO
State	:	GA
Zip	:	30238-5945
Country	:	US
Telephone Number	:	770-231-7661
Fax Number	:	770-210-8497

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. CORDELIA O OKWANDU
Credential	:	BBA, MA, CNA
Telephone Number	:	770-231-7661

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/21/2022

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