# COLEMAN & STALLWORTH REAL ESTATE HOLDING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Professional Care Givers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902059439
- **Authorized official:** HENRY STALLWORTH (PRESIDENT)
- **Authorized official phone:** (678) 602-0183

## Contact information

- **Practice address:** 4363 AZALEA WALK, ELLENWOOD, GA 30294-6552
- **Practice address phone:** (404) 244-3292
- **Practice address fax:** (404) 244-3414
- **Mailing address:** 4363 AZALEA WALK, ELLENWOOD, GA 30294-6552
- **Mailing address phone:** (404) 244-3292
- **Mailing address fax:** (404) 244-3414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 044--R-0499 | GA | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 044-R-0499 | GA | — |

## Other

- **Enumeration date:** 10/28/2008
- **Last updated:** 06/15/2009