Organization
COLEMAN & STALLWORTH REAL ESTATE HOLDING, LLC
Active
Other names
Professional Care Givers
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY STALLWORTH (PRESIDENT)
(678) 602-0183
Entity
Organization
Contact information
Practice address
4363 AZALEA WALK, ELLENWOOD, GA 30294-6552
(404) 244-3292
(404) 244-3414
Mailing address
4363 AZALEA WALK, ELLENWOOD, GA 30294-6552
(404) 244-3292
(404) 244-3414
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
044--R-0499
GA
332B00000X
Durable Medical Equipment & Medical Supplies
044-R-0499
GA
Other
Enumeration date
10/28/2008
Last updated
06/15/2009
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