Provider Demographics
NPI:1083864664
Name:ACCUMED HEALTH SERVICES OF GEORGIA, INC.
Entity Type:Organization
Organization Name:ACCUMED HEALTH SERVICES OF GEORGIA, INC.
Other - Org Name:COMMUNITY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:37 CALUMET PARKWAY #P
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6735
Practice Address - Country:US
Practice Address - Phone:770-683-2060
Practice Address - Fax:770-683-2069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCUMED HEALTH SERVICES OF GEORGIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-263251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00824942GMedicaid