Provider Demographics
NPI:1851080477
Name:FIDELIS HEALTHCARE PROFESSIONALS LLC
Entity Type:Organization
Organization Name:FIDELIS HEALTHCARE PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KISSIAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUPLESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-596-3361
Mailing Address - Street 1:PO BOX 1916
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-6429
Mailing Address - Country:US
Mailing Address - Phone:678-596-3361
Mailing Address - Fax:
Practice Address - Street 1:12461 VETERANS MEMORIAL HWY STE 837
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2025
Practice Address - Country:US
Practice Address - Phone:770-722-2034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health