MEDICARE: EMPYREAN HOSPICE OF GEORGIA, 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	:	1730862764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPYREAN HOSPICE OF GEORGIA, LLC

Provider Business Mailing Address
First Line	:	647 BRAWLEY SCHOOL RD STE 104
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-6876
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 AUGUSTA WEST PKWY STE 201
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1808
Country	:	US
Telephone Number	:	706-842-7477
Fax Number	:

Authorized Official
Title or Position	:	CAO
Name	:	STEPHANIE BAHETH
Credential	:
Telephone Number	:	980-920-3676

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	03/16/2026

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