Provider Demographics
NPI:1457682007
Name:AMEDISYS GEORGIA, LLC
Entity Type:Organization
Organization Name:AMEDISYS GEORGIA, LLC
Other - Org Name:AMEDISYS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:190 WESTSIDE DR
Practice Address - Street 2:SUITE E
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3533
Practice Address - Country:US
Practice Address - Phone:912-383-0840
Practice Address - Fax:912-383-0838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEDISYS GEORGIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-21
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA148-110251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000826009JMedicaid
GA000826009JMedicaid