Provider Demographics
NPI:1639414022
Name:ALLIED HEALTH SERVICES GEORGIA
Entity Type:Organization
Organization Name:ALLIED HEALTH SERVICES GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KARGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-763-0055
Mailing Address - Street 1:5530 OLD NATIONAL HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3356
Mailing Address - Country:US
Mailing Address - Phone:404-763-0055
Mailing Address - Fax:404-763-0058
Practice Address - Street 1:5530 OLD NATIONAL HWY
Practice Address - Street 2:SUITE C
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3356
Practice Address - Country:US
Practice Address - Phone:404-763-0055
Practice Address - Fax:404-763-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-0952253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care