MEDICARE: PURE INFUSION 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	261QI0500X	Infusion Therapy Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1982586343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE INFUSION OF GEORGIA LLC

Provider Business Mailing Address
First Line	:	4179 S RIVERBOAT RD STE 220
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84123-2986
Country	:	US
Telephone Number	:	801-590-9267
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 PERIMETER PARK DR STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1318
Country	:	US
Telephone Number	:	770-847-8900
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PAYER DEVELOPMENT
Name	:	RACHEL FRAGA
Credential	:
Telephone Number	:	801-921-6325

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	10/07/2025

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