MEDICARE: THE MEDI GROUP. 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1215281431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MEDI GROUP. LLC

Provider Business Mailing Address
First Line	:	1257 COMMERCIAL DR SW STE B
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-5991
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1257 COMMERCIAL DR SW STE B
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-5991
Country	:	US
Telephone Number	:	770-483-6393
Fax Number	:	770-825-9977

Authorized Official
Title or Position	:	DIRECTOR OF ADMINISTRATION
Name	:	JESSICA LANE
Credential	:
Telephone Number	:	770-483-6393

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	11/09/2012

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