MEDICARE: KEYANNA PROFESSIONAL SERVICES, LTD COMPANY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	253Z00000X	In Home Supportive Care Agency
3	385H00000X	Respite Care
4	343900000X	Non-emergency Medical Transport (VAN)
5	177F00000X	Lodging Provider
6	342000000X	Transportation Network Company
7	335G00000X	Medical Foods Supplier
8	347C00000X	Private Vehicle
9	332U00000X	Home Delivered Meals
10	343800000X	Secured Medical Transport (VAN)
11	171W00000X	Contractor

General Provider Information

NPI Number	:	1568232072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYANNA PROFESSIONAL SERVICES, LTD COMPANY

Provider Business Mailing Address
First Line	:	PO BOX 112
Second Line	:
City	:	SPARTA
State	:	GA
Zip	:	31087-0112
Country	:	US
Telephone Number	:	470-553-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 CLEVELAND RD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-9654
Country	:	US
Telephone Number	:	470-550-8882
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEYANNA MOSS
Credential	:	MBA
Telephone Number	:	470-553-8500

Provider Enumeration Date	:	01/05/2024
Last Update Date	:	11/15/2025

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Directions to “KEYANNA PROFESSIONAL SERVICES, LTD COMPANY ” Practice Location

Language	Start Address	Practice Location

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