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
4408 COLUMBIA RD, UNITS 100 & 102, MARTINEZ, GA 30907-4554
(706) 868-6543
(706) 868-9754
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
121-R-0003
GA
251J00000X
Nursing Care Agency
Primary
121-265H
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00974278A
—
GA
05
—
538807248B
—
GA
05
—
538807248D
—
GA
05
—
538807248E
—
GA
05
—
EX0445
—
SC
05
—
EXG033
—
SC
Enumeration date
07/07/2006
Last updated
01/27/2025
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