MEDICARE: ATLANTA STRUCTURED FAMILY SERVICES

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

General Provider Information

NPI Number	:	1700559721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA STRUCTURED FAMILY SERVICES

Provider Business Mailing Address
First Line	:	1789 WASHINGTON RD STE C
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-4149
Country	:	US
Telephone Number	:	623-312-9157
Fax Number	:

Provider Business Practice Location Address
First Line	:	1789 WASHINGTON RD STE C
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-4149
Country	:	US
Telephone Number	:	623-312-9157
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	URSULA LAWRENCE
Credential	:
Telephone Number	:	623-282-4143

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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