Basic Information
| Provider Information | |||||||||
| NPI: | 1427275825 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMEDISYS GEORGIA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TUGALOO HOME HEALTH AGENCY AN AMEDISY COMPANY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3854 AMERICAN WAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708164013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252922031 | ||||||||
| FaxNumber: | 2252959678 | ||||||||
| Practice Location | |||||||||
| Address1: | 417 BLUE RIDGE ST | ||||||||
| Address2: | SUITE K | ||||||||
| City: | BLAIRSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305123673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067811093 | ||||||||
| FaxNumber: | 7067811246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | KUSSEROW | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2252922031 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMEDISYS GEORGIA LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 069-247 | GA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 00832455B | 05 | GA | MEDICAID |