Organization
PEDIATRIC SERVICES OF AMERICA, LLC
Active
Organization
PEDIATRIC SERVICES OF AMERICA, LLC
Active
Other names
Aveanna Heatlhcare
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BUCKHALTER (CFO)
(470) 464-8000
Entity
Organization
Contact information
Practice address
225 COUNTRY CLUB DR STE 240, STOCKBRIDGE, GA 30281-7339
(770) 810-6922
(770) 810-6930
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
251J00000X
Nursing Care Agency
Primary
106-R-0941
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
675782530B
—
GA
Enumeration date
07/14/2011
Last updated
01/27/2025
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