Provider Demographics
NPI:1992016877
Name:STG HEALTHCARE OF ATLANTA, INC
Entity Type:Organization
Organization Name:STG HEALTHCARE OF ATLANTA, INC
Other - Org Name:INTERIM HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PASCAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-843-2708
Mailing Address - Street 1:5555 GLENRIDGE CONNECTOR
Mailing Address - Street 2:SUITE 750
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4759
Mailing Address - Country:US
Mailing Address - Phone:404-856-6110
Mailing Address - Fax:404-252-7590
Practice Address - Street 1:5555 GLENRIDGE CONNECTOR
Practice Address - Street 2:SUITE 750
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4759
Practice Address - Country:US
Practice Address - Phone:404-856-6110
Practice Address - Fax:404-252-7590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STG HEALTHCARE OF ATLANTA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-25
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11-1713Medicare PIN