Organization
PRIVATE HOME ASSISTANCE OF GEORGIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL BROWN NHA (ADMINISTRATOR)
(678) 355-6000
Entity
Organization
Contact information
Practice address
707 WHITLOCK AVE SW, SUITE F-3, MARIETTA, GA 30064-3000
(678) 355-6000
(678) 355-6077
Mailing address
707 WHITLOCK AVE SW, SUITE F-3, MARIETTA, GA 30064-3000
(678) 355-6000
(678) 355-6077
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
033-R-0085
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
530581025A
—
GA
05
—
530581025B
—
GA
Enumeration date
11/06/2006
Last updated
04/23/2013
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