Provider Demographics
NPI:1285406355
Name:BRIGHTSTARS HOME CARE OF GEORGIA
Entity type:Organization
Organization Name:BRIGHTSTARS HOME CARE OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMEL
Authorized Official - Middle Name:CHATULUKA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-604-0555
Mailing Address - Street 1:4095 JAMES LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288-1379
Mailing Address - Country:US
Mailing Address - Phone:404-604-0555
Mailing Address - Fax:
Practice Address - Street 1:4095 JAMES LAKE DR
Practice Address - Street 2:
Practice Address - City:CONLEY
Practice Address - State:GA
Practice Address - Zip Code:30288-1379
Practice Address - Country:US
Practice Address - Phone:404-604-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care