Provider Demographics
NPI:1730241233
Name:ATL-SOUTH HEALTH SERVICES
Entity type:Organization
Organization Name:ATL-SOUTH HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOAKUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-907-2323
Mailing Address - Street 1:253 UPPER RIVERDALE RD SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4945
Mailing Address - Country:US
Mailing Address - Phone:770-907-2323
Mailing Address - Fax:770-907-2122
Practice Address - Street 1:253 UPPER RIVERDALE RD SW
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4945
Practice Address - Country:US
Practice Address - Phone:770-907-2323
Practice Address - Fax:770-907-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-R-0034251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health