HEALTHCARE AT HOME LLC NPI 1174057194

NPI Information

NPI: 1174057194
Provider Name: HEALTHCARE AT HOME LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 11D2138810

Address:
5040 SNAPFINGER WOODS DR STE 104
DECATUR, GA
ZIP 30035
Phone: (678) 777-7165
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HEALTHCARE AT HOME LLC is a family nurse practitioner in Decatur, GA. HEALTHCARE AT HOME LLC NPI is 1174057194. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5040 SNAPFINGER WOODS DR STE 104
DECATUR, GA
ZIP 30035-020
Phone: (678) 777-7165
Fax: (563) 202-6972

The provider's authorized official is Tricia Salmon Anderson .
The authorized official title is Family Nurse Practitioner and has the following contact phone number (678) 777-7165.

The CLIA number assigned to this NPI record is 11D2138810 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/17/2017 and was last updated on 4/26/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	195112	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	003154719D	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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