Provider Demographics
NPI:1457935660
Name:FAITH HOSPICE OF ATLANTA LLC
Entity Type:Organization
Organization Name:FAITH HOSPICE OF ATLANTA LLC
Other - Org Name:FAITH HOSPICE OF ATLANTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MERECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-757-7585
Mailing Address - Street 1:1755 THE EXCHANGE SE STE 342
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7434
Mailing Address - Country:US
Mailing Address - Phone:678-310-1790
Mailing Address - Fax:
Practice Address - Street 1:1755 THE EXCHANGE SE STE 342
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7434
Practice Address - Country:US
Practice Address - Phone:678-310-1790
Practice Address - Fax:678-868-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based