Provider Demographics
NPI:1003032475
Name:AMEDISYS GEORGIA LLC
Entity Type:Organization
Organization Name:AMEDISYS GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:691 441 HISTORIC HWY N
Practice Address - Street 2:SUITE 6
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4569
Practice Address - Country:US
Practice Address - Phone:866-464-9124
Practice Address - Fax:866-268-3586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055-240251E00000X
GA059-240-H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00824909CMedicaid
GA117036Medicare Oscar/Certification