Provider Demographics
NPI:1104493550
Name:FAMILY HEALTHCARE OF GEORGIA, LLC
Entity type:Organization
Organization Name:FAMILY HEALTHCARE OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-530-6979
Mailing Address - Street 1:3355 LENOX RD NE STE 1000
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-2000
Mailing Address - Country:US
Mailing Address - Phone:678-679-7244
Mailing Address - Fax:
Practice Address - Street 1:3355 LENOX RD NE STE 1000
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-2000
Practice Address - Country:US
Practice Address - Phone:678-679-7244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty