Provider Demographics
NPI:1467882795
Name:HOMECARE MEDICINE OF ATLANTA LLC
Entity Type:Organization
Organization Name:HOMECARE MEDICINE OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-271-4480
Mailing Address - Street 1:3330 CUMBERLAND BLVD SE
Mailing Address - Street 2:STE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5995
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3330 CUMBERLAND BLVD SE
Practice Address - Street 2:STE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5995
Practice Address - Country:US
Practice Address - Phone:770-740-2611
Practice Address - Fax:770-800-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67534207R00000X
GA68460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty