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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