Provider Demographics
NPI:1336490283
Name:QUALICARE OF GEORGIA, INC
Entity Type:Organization
Organization Name:QUALICARE OF GEORGIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:UMUNNAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-819-4992
Mailing Address - Street 1:1755 THE EXCHANGE SE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7400
Mailing Address - Country:US
Mailing Address - Phone:678-508-6146
Mailing Address - Fax:
Practice Address - Street 1:2370 GREYTHORNE CMNS
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8103
Practice Address - Country:US
Practice Address - Phone:404-819-4992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-1079251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care