Provider Demographics
NPI:1306304852
Name:VILLAGE AT HOME OF GEORGIA PLLC LLC
Entity type:Organization
Organization Name:VILLAGE AT HOME OF GEORGIA PLLC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-969-0686
Mailing Address - Street 1:PO BOX 392966
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261-6263
Mailing Address - Country:US
Mailing Address - Phone:844-969-0686
Mailing Address - Fax:
Practice Address - Street 1:3445 PEACHTREE RD NE STE 1200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-3251
Practice Address - Country:US
Practice Address - Phone:678-508-6832
Practice Address - Fax:470-387-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty