Provider Demographics
NPI:1194035766
Name:HOME HEALTH AGENCY OF GEORGIA, LLC
Entity Type:Organization
Organization Name:HOME HEALTH AGENCY OF GEORGIA, LLC
Other - Org Name:CAMELLIA HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:601-544-2903
Mailing Address - Street 1:135 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1464
Mailing Address - Country:US
Mailing Address - Phone:601-544-2903
Mailing Address - Fax:601-264-3512
Practice Address - Street 1:1705 ENTERPRISE WAY SE
Practice Address - Street 2:SUITE 102
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9224
Practice Address - Country:US
Practice Address - Phone:678-218-5745
Practice Address - Fax:770-794-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033 034 10 H251G00000X
GA033-0340-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based