Provider Demographics
NPI:1114666120
Name:LIBERTY HOME HEALTH, LLC DBA CARELAB GEORGIA
Entity Type:Organization
Organization Name:LIBERTY HOME HEALTH, LLC DBA CARELAB GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-510-5584
Mailing Address - Street 1:2730 N BERKELEY LAKE RD NW STE 1213
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1748
Mailing Address - Country:US
Mailing Address - Phone:678-557-4329
Mailing Address - Fax:
Practice Address - Street 1:2730 N BERKELEY LAKE RD NW STE 1213
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1748
Practice Address - Country:US
Practice Address - Phone:678-557-4329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty