Organization · NPI-2
Providence Healthcare Of Georgia
Registered Nurse, Home Health · Mableton, GA
NPI number1720618077
StatusActive
Last updated in NPPESSep 26, 2025
Details
- NPI
- 1720618077
- Entity type
- Organization (NPI-2)
- Legal business name
- Providence Healthcare Of Georgia
- Organization subpart
- No
- Enumeration date
- Jan 24, 2020
- Certification date
- Sep 26, 2025
- Last updated
- Sep 26, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WH0200X | Registered Nurse, Home Health | – | – | Yes |
| 251B00000X | Case Management | – | – | |
| 251E00000X | Home Health | – | – | |
| 253Z00000X | In Home Supportive Care | – | – | |
| 251S00000X | Community/Behavioral Health | – | – | |
| 251J00000X | Nursing Care | – | – |
Other names
- Phg Healthcare (Doing Business As)
Practice location
6509 Bennington Bluff CtMableton, GA 30126-7269
Phone 404-408-8703
Mailing address
6509 Bennington Bluff CtMableton, GA 30126-7269
Authorized official
Neiya Speller
Administrator
6316786889
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