Provider Demographics
NPI:1528294477
Name:GUARDIAN HOSPICE OF GEORGIA, LLC
Entity type:Organization
Organization Name:GUARDIAN HOSPICE OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF HOSPICE
Authorized Official - Prefix:MS
Authorized Official - First Name:JEWELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-672-7977
Mailing Address - Street 1:17855 DALLAS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6852
Mailing Address - Country:US
Mailing Address - Phone:972-267-1100
Mailing Address - Fax:972-267-1115
Practice Address - Street 1:4360 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:SUITE 535
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1049
Practice Address - Country:US
Practice Address - Phone:770-458-1624
Practice Address - Fax:770-458-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-190-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111616Medicare Oscar/Certification