Provider Demographics
NPI:1174057194
Name:HEALTHCARE AT HOME LLC
Entity type:Organization
Organization Name:HEALTHCARE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALMON ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:678-777-7165
Mailing Address - Street 1:5243 SNAPFINGER WOODS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4000
Mailing Address - Country:US
Mailing Address - Phone:678-777-7165
Mailing Address - Fax:563-202-6972
Practice Address - Street 1:5040 SNAPFINGER WOODS DR STE 104
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4020
Practice Address - Country:US
Practice Address - Phone:678-777-7165
Practice Address - Fax:563-202-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA195112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003154719DMedicaid