Provider Demographics
NPI:1679725022
Name:GEORGIA HOUSECALLS, LLC
Entity Type:Organization
Organization Name:GEORGIA HOUSECALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER 49
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:404-790-0911
Mailing Address - Street 1:2020 HOWELL MILL RD NW
Mailing Address - Street 2:STE 168
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1732
Mailing Address - Country:US
Mailing Address - Phone:404-790-0911
Mailing Address - Fax:
Practice Address - Street 1:2020 HOWELL MILL RD NW
Practice Address - Street 2:STE 168
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1732
Practice Address - Country:US
Practice Address - Phone:404-790-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039684251E00000X
GA004135251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA221778463Medicare UPIN