Provider Demographics
NPI:1740406156
Name:AMEDISYS GEORGIA LLC
Entity Type:Organization
Organization Name:AMEDISYS GEORGIA LLC
Other - Org Name:TUGALOO HOME HEALTH AGENCY AN AMEDISYS COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:75 N MAIN ST
Practice Address - Street 2:STE 105
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4264
Practice Address - Country:US
Practice Address - Phone:800-348-2852
Practice Address - Fax:866-268-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059-240251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000189164FMedicaid
GA00824909EMedicaid
GA000189164FMedicaid