Organization
PEDIATRIC SERVICES OF AMERICA, LLC
Active
Other names
Aveanna Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BUCKHALTER (CFO)
(470) 464-8000
Entity
Organization
Contact information
Practice address
4931 RIVERSIDE DR STE 300B, MACON, GA 31210-1193
(478) 841-2772
(478) 745-2712
Mailing address
400 INTERSTATE NORTH PKWY SE STE 1600, ATLANTA, GA 30339-5047
(470) 464-8000
(770) 248-8192
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
011-268
GA
251J00000X
Nursing Care Agency
Primary
011-R-0026
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000426676I
—
GA
05
—
675782530A
—
GA
Enumeration date
07/05/2006
Last updated
01/27/2025
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