MEDICARE: ME AND MY NANNA, 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	251E00000X	Home Health Agency	060R0147	GA
2	251J00000X	Nursing Care Agency	060-R-0147	GA
3	253Z00000X	In Home Supportive Care Agency	060-R-0147	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699733279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ME AND MY NANNA, LLC

Provider Business Mailing Address
First Line	:	5878 BUFORD HWY., STE. 9
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340-1245
Country	:	US
Telephone Number	:	678-381-1540
Fax Number	:	877-496-4822

Provider Business Practice Location Address
First Line	:	5878 BUFORD HWY.,
Second Line	:	STE. 9
City	:	ATLANTA
State	:	GA
Zip	:	30340-1245
Country	:	US
Telephone Number	:	678-381-1540
Fax Number	:	877-496-4822

Authorized Official
Title or Position	:	PRES/CEO
Name	:	MRS. TONGIE R. SCOTT
Credential	:
Telephone Number	:	678-471-5338

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	06/14/2013

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Directions to “ME AND MY NANNA, LLC ” Practice Location

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