MEDICARE: HIS MERCIES HOME HEALTH SERVICES

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	:	1225504756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIS MERCIES HOME HEALTH SERVICES

Provider Business Mailing Address
First Line	:	7603 FOREST GLEN WAY
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-6868
Country	:	US
Telephone Number	:	470-331-9468
Fax Number	:

Provider Business Practice Location Address
First Line	:	7603 FOREST GLEN WAY
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-6868
Country	:	US
Telephone Number	:	470-331-9468
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VIVIAN ADU-ABOAGYE
Credential	:	NURSE PRACTITIONER
Telephone Number	:	470-331-9468

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	10/23/2018

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