Provider Demographics
NPI:1417217712
Name:AT HOME ATLANTA LLC
Entity Type:Organization
Organization Name:AT HOME ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-498-4100
Mailing Address - Street 1:6067 WINDSONG WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1943
Mailing Address - Country:US
Mailing Address - Phone:770-498-4100
Mailing Address - Fax:770-498-4101
Practice Address - Street 1:1505 LILBURN STONE MOUNTAIN RD
Practice Address - Street 2:250
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1857
Practice Address - Country:US
Practice Address - Phone:770-498-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AT HOME ATLANTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-21
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00228039251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health