Provider Demographics
NPI:1558890442
Name:MAXMATH TUTORING ONLINE INC GEORGIA BRANCH
Entity Type:Organization
Organization Name:MAXMATH TUTORING ONLINE INC GEORGIA BRANCH
Other - Org Name:MAXMATH HOME HEALTH CARE AGENCY OF GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-MAXCENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-959-4159
Mailing Address - Street 1:2650 BENTLEY RD SE APT 10K
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8821
Mailing Address - Country:US
Mailing Address - Phone:888-959-4159
Mailing Address - Fax:888-959-4173
Practice Address - Street 1:2650 BENTLEY RD SE APT 10K
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8821
Practice Address - Country:US
Practice Address - Phone:888-959-4159
Practice Address - Fax:888-959-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11010052251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11010052Medicaid