MEDICARE: HOLIGENIX HEALTHCARE 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

General Provider Information

NPI Number	:	1770341067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLIGENIX HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	4014 OPHIE DR NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-2330
Country	:	US
Telephone Number	:	228-229-7379
Fax Number	:

Provider Business Practice Location Address
First Line	:	4014 OPHIE DR NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-2330
Country	:	US
Telephone Number	:	228-229-7379
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RODNEY WILLIAMS
Credential	:
Telephone Number	:	228-229-7379

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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