Provider Demographics
NPI:1326598681
Name:COMPASSUS OP OF GEORGIA I LLC
Entity Type:Organization
Organization Name:COMPASSUS OP OF GEORGIA I LLC
Other - Org Name:COMPASSUS HOSPICE AND PALLIATIVE CARE - ATLANTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-224-8028
Mailing Address - Street 1:3720 DAVINCI CT
Mailing Address - Street 2:STE 400
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-7627
Mailing Address - Country:US
Mailing Address - Phone:770-417-2018
Mailing Address - Fax:888-652-6961
Practice Address - Street 1:3720 DAVINCI CT
Practice Address - Street 2:STE 400
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7627
Practice Address - Country:US
Practice Address - Phone:770-417-2018
Practice Address - Fax:888-652-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
111639Medicare Oscar/Certification