MEDICARE: ACCORD HOSPICE OF ATLANTA

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	:	1801281654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCORD HOSPICE OF ATLANTA

Provider Business Mailing Address
First Line	:	2740 JEFFERSON ST
Second Line	:	SUITE A5
City	:	AUSTELL
State	:	GA
Zip	:	30168-4014
Country	:	US
Telephone Number	:	678-698-1480
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 JEFFERSON ST
Second Line	:	SUITE A5
City	:	AUSTELL
State	:	GA
Zip	:	30168-4014
Country	:	US
Telephone Number	:	678-698-1480
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NIXON UKENNA ONYIRIMBA
Credential	:
Telephone Number	:	678-698-1480

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	03/30/2015

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