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NPI Code Detail

MEDICARE: FUNDAMENTAL HEALTH GROUP, LLC

MEDICARE: FUNDAMENTAL HEALTH GROUP, 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
1251J00000XNursing Care Agency
2251S00000XCommunity/Behavioral Health Agency
3253Z00000XIn Home Supportive Care Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1060-R-1213OTHERGAHOME CARE PROVIDER LICENSE - SKILLED NURSING, PERSONAL CARE, & COMPANION/SITTER
2563170OTHERGAJOINT COMMISSION ACCRED
3SCSA095804OTHERGACERTIFIED SENIOR ADVISOR

General Provider Information

NPI Number : 1588098529
Entity Type Code : Organization
Provider Name (Legal Business Name) : FUNDAMENTAL HEALTH GROUP, LLC
Provider Business Mailing Address
First Line : 550 PEACHTREE ST NE
Second Line : SUITE 1210
City : ATLANTA
State : GA
Zip : 30308-2237
Country : US
Telephone Number : 404-856-7610
Fax Number : 866-266-5030
Provider Business Practice Location Address
First Line : 550 PEACHTREE ST NE
Second Line : SUITE 1210
City : ATLANTA
State : GA
Zip : 30308-2237
Country : US
Telephone Number : 404-856-7610
Fax Number : 866-266-5030
Authorized Official
Title or Position : PRESIDENT
Name : MR. ADAM JACOB FRASER
Credential : CSA
Telephone Number : 404-856-7610
Provider Enumeration Date : 08/27/2013
Last Update Date : 05/28/2015

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Directions to “FUNDAMENTAL HEALTH GROUP, LLC ” Practice Location

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