Provider Demographics
NPI:1235187980
Name:AMEDISYS GEORGIA, L.L.C.
Entity Type:Organization
Organization Name:AMEDISYS GEORGIA, L.L.C.
Other - Org Name:TUGLAOO HOME HEALTH AGENCY, AN AMEDISYS COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP TAX
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGLICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3803
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 1:817 GROGAN ST
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-1805
Practice Address - Country:US
Practice Address - Phone:706-356-8480
Practice Address - Fax:866-268-3537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059-240-H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000189109FMedicaid
GA000189164FMedicaid
GA00824909BMedicaid
GA00824909CMedicaid
GA00824909AMedicaid
GA00824909AMedicaid