MEDICARE: PROSPER AUGUSTA, 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	:	1679100275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPER AUGUSTA, LLC

Provider Business Mailing Address
First Line	:	3088 MERCER UNIVERSITY DR STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-4140
Country	:	US
Telephone Number	:	404-784-3365
Fax Number	:

Provider Business Practice Location Address
First Line	:	1287 MARKS CHURCH RD STE A
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2497
Country	:	US
Telephone Number	:	705-504-3770
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DOUGLAS LUEDER
Credential	:
Telephone Number	:	404-784-3365

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/24/2020

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