Provider Demographics
NPI:1689982670
Name:TRANSITIONAL GEORGIA LLC
Entity Type:Organization
Organization Name:TRANSITIONAL GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LATANYALIKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOATWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-230-8229
Mailing Address - Street 1:2931 STREAM VW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-7982
Mailing Address - Country:US
Mailing Address - Phone:678-230-8229
Mailing Address - Fax:404-935-9630
Practice Address - Street 1:9546 CARNES CROSSING CIR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-6279
Practice Address - Country:US
Practice Address - Phone:678-230-8229
Practice Address - Fax:404-935-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031012859251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health