Provider Demographics
NPI:1407924467
Name:JOURNEY HOSPICE OF ATLANTA, LLC
Entity Type:Organization
Organization Name:JOURNEY HOSPICE OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-387-5100
Mailing Address - Street 1:4800 ASHFORD DUNWOODY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4897
Mailing Address - Country:US
Mailing Address - Phone:404-256-2454
Mailing Address - Fax:
Practice Address - Street 1:4800 ASHFORD DUNWOODY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4897
Practice Address - Country:US
Practice Address - Phone:404-256-2454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111647Medicare ID - Type Unspecified