Provider Demographics
NPI:1164878302
Name:SYNERGY HOMECARE OF NW ATLANTA
Entity Type:Organization
Organization Name:SYNERGY HOMECARE OF NW ATLANTA
Other - Org Name:A PLACE OF GRACE & MERCY, INC. DBA SYNERGY HOMECARE OF NW ATLANTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS-MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-909-3043
Mailing Address - Street 1:5604 WENDY BAGWELL PKWY
Mailing Address - Street 2:SUITE 321
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-7813
Mailing Address - Country:US
Mailing Address - Phone:678-909-3043
Mailing Address - Fax:678-426-6060
Practice Address - Street 1:5604 WENDY BAGWELL PKWY
Practice Address - Street 2:SUITE 321
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7813
Practice Address - Country:US
Practice Address - Phone:678-909-3043
Practice Address - Fax:678-426-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110R1136253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care