Organization
DRD PRIVATE HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DE'SHALAH POTTER (MANAGER)
(470) 412-0295
Entity
Organization
Contact information
Practice address
7712 AUTRY CIR APT 310, DOUGLASVILLE, GA 30134-5730
(470) 276-4515
(470) 228-5106
Mailing address
7712 AUTRY CIR APT 310, DOUGLASVILLE, GA 30134-5730
(470) 276-4515
(470) 228-5106
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
02/10/2025
Last updated
05/19/2025
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