Organization
FAMILY HOSPICE AND PALLIATIVE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONY ETHERIDGE (CONSULTANT)
(239) 851-1918
Entity
Organization
Contact information
Practice address
435 W BANKHEAD HWY, VILLA RICA, GA 30180-1702
(800) 410-4663
(706) 807-6941
Mailing address
435 W BANKHEAD HWY, VILLA RICA, GA 30180-1702
(800) 410-4663
(706) 807-6941
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
05/21/2024
Last updated
08/23/2024
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