MEDICARE: ATLANTA HOMECARE SERVICES, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1306646716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA HOMECARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	4690 STERLING OAKS CT
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3683
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4690 STERLING OAKS CT
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3683
Country	:	US
Telephone Number	:	678-404-9598
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LILY PHAM
Credential	:
Telephone Number	:	678-895-2039

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	03/19/2025

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