Provider Demographics
NPI:1396372363
Name:LAMAR AGENCY
Entity Type:Organization
Organization Name:LAMAR AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALTHISHA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-884-9447
Mailing Address - Street 1:3085 BROMBLEY DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6483
Mailing Address - Country:US
Mailing Address - Phone:404-884-9447
Mailing Address - Fax:844-597-1762
Practice Address - Street 1:3040 PEACHTREE RD NW UNIT 1010
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2290
Practice Address - Country:US
Practice Address - Phone:770-239-1471
Practice Address - Fax:844-597-1762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health