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NPI Code Detail

MEDICARE: FAMILY HEALTHCARE OF GEORGIA, LLC

MEDICARE: FAMILY HEALTHCARE OF GEORGIA, LLC
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
1163WH0200XHome Health Registered Nurse

General Provider Information

NPI Number : 1104493550
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY HEALTHCARE OF GEORGIA, LLC
Provider Business Mailing Address
First Line : 3355 LENOX RD NE STE 1000
Second Line :
City : ATLANTA
State : GA
Zip : 30326-2000
Country : US
Telephone Number : 678-679-7244
Fax Number :
Provider Business Practice Location Address
First Line : 3355 LENOX RD NE STE 1000
Second Line :
City : ATLANTA
State : GA
Zip : 30326-2000
Country : US
Telephone Number : 678-679-7244
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. DWAYNE LATTIMORE
Credential :
Telephone Number : 470-530-6979
Provider Enumeration Date : 06/04/2021
Last Update Date : 06/04/2021

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Directions to “FAMILY HEALTHCARE OF GEORGIA, LLC ” Practice Location

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