Basic Information
| Provider Information | |||||||||
| NPI: | 1396804894 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PORTSBRIDGE HOSPICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 PHOENIX BLVD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303495593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782845850 | ||||||||
| FaxNumber: | 7707165502 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 N MILLEDGE AVE | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306013805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063690917 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EKPE | ||||||||
| AuthorizedOfficialFirstName: | TUWANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL BILLER | ||||||||
| AuthorizedOfficialTelephone: | 6782845865 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.