MEDICARE: ALLWELL HEALTHCARE OF GEORGIA INC

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	033-R-1322	GA

General Provider Information

NPI Number	:	1376911750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLWELL HEALTHCARE OF GEORGIA INC

Provider Business Mailing Address
First Line	:	4171 MARIETTA ST
Second Line	:	SUITE 300B
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2696
Country	:	US
Telephone Number	:	678-923-4637
Fax Number	:

Provider Business Practice Location Address
First Line	:	4171 MARIETTA ST
Second Line	:	SUITE 300B
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2696
Country	:	US
Telephone Number	:	678-923-4637
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SYLVESTER ONOYONA
Credential	:
Telephone Number	:	678-923-4637

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	09/02/2015

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