Basic Information
| Provider Information | |||||||||
| NPI: | 1437117090 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMEDISYS GEORGIA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTRAL HOME HEALTH CARE, AN AMEDISYS 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: | 3009 CHAPEL HILL RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301351748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709421609 | ||||||||
| FaxNumber: | 7709422632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | KUSSEROW | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2252922031 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 048-241-H | GA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 00824942D | 05 | GA | MEDICAID | 00824942A | 05 | GA | MEDICAID | 00824942G | 05 | GA | MEDICAID | 00824942B | 05 | GA | MEDICAID | 000824942F | 05 | GA | MEDICAID | 00824942E | 05 | GA | MEDICAID |