MEDICARE: PRIORITY HOSPICE 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1659027944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIORITY HOSPICE LLC

Provider Business Mailing Address
First Line	:	101 DEVANT ST STE 306
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-2714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 DEVANT ST STE 306
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-2714
Country	:	US
Telephone Number	:	678-545-4399
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EBONY PHILLIPS
Credential	:
Telephone Number	:	678-545-4399

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	10/21/2024

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