# GEORGIA IN HOME SUPPORT SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063424752
- **Authorized official:** MS. SHANTEL MARIE FORSTALL MSW (ADMINISTRATOR)
- **Authorized official phone:** (678) 817-7338

## Contact information

- **Practice address:** 155 ZELKOVA DR, FAYETTEVILLE, GA 30215-2528
- **Practice address phone:** (678) 817-7338
- **Mailing address:** 155 ZELKOVA DR, FAYETTEVILLE, GA 30215-2528
- **Mailing address phone:** (678) 817-7338

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 056-R-0260 | GA | Yes |
| 251J00000X | Nursing Care Agency | 056-R-0260 | GA | — |

## Other

- **Enumeration date:** 08/12/2006
- **Last updated:** 09/11/2025