Provider Demographics
NPI:1689790867
Name:MEDSIDE PALLIATIVE CARE
Entity Type:Organization
Organization Name:MEDSIDE PALLIATIVE CARE
Other - Org Name:MEDSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHA/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORABELNIKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-633-7433
Mailing Address - Street 1:PO BOX 190996
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31119-0996
Mailing Address - Country:US
Mailing Address - Phone:404-633-7433
Mailing Address - Fax:888-633-7430
Practice Address - Street 1:3384 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1181
Practice Address - Country:US
Practice Address - Phone:404-633-7433
Practice Address - Fax:888-633-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00849527AMedicaid
GA060-R-0068OtherMEDSIDE HOME CARE AGENCY
GA0606-245-HOtherSTATE ID LICENSE
GA1306858121OtherNPI
GA1306858121OtherNPI