MEDICARE: VILLAGE AT HOME OF GEORGIA PLLC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1306304852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE AT HOME OF GEORGIA PLLC LLC

Provider Business Mailing Address
First Line	:	PO BOX 392966
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15261-6263
Country	:	US
Telephone Number	:	844-969-0686
Fax Number	:

Provider Business Practice Location Address
First Line	:	3445 PEACHTREE RD NE STE 1200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3251
Country	:	US
Telephone Number	:	678-508-6832
Fax Number	:	470-387-1639

Authorized Official
Title or Position	:	DIRECTOR REVENUE CYCLE
Name	:	REBECCA RAGER
Credential	:
Telephone Number	:	844-969-0686

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	01/10/2025

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