| Homestead Hospice Of South Georgia, Llc | |
|
126 S Access Rd Chula GA 31733-4204 | |
| (229) 520-3052 | |
| (229) 520-3062 |
| Full Name | Homestead Hospice Of South Georgia, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 126 S Access Rd, Chula, Georgia |
| Authorized Official Name and Position | John Kerndl (CFO & SECRETARY) |
| Authorized Official Contact | 9797046547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Homestead Hospice Of South Georgia, Llc 6840 Carothers Pkwy Ste 550 Franklin TN 37067-8002 Ph: (979) 704-6547 | Homestead Hospice Of South Georgia, Llc 126 S Access Rd Chula GA 31733-4204 Ph: (229) 520-3052 |
| NPI Number | 1811635253 |
|---|---|
| Provider Enumeration Date | 05/25/2022 |
| Last Update Date | 06/21/2024 |
| Medicare PECOS PAC ID | 8022372549 |
|---|---|
| Medicare Enrollment ID | O20220722002642 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811635253 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Anthony G Captain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023035094 PECOS PAC ID: 0749259661 Enrollment ID: I20050228000463 |
| Provider Name | Ayman Rihawi |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1326097387 PECOS PAC ID: 8426004375 Enrollment ID: I20050324000082 |
| Provider Name | Carl Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023018561 PECOS PAC ID: 4688869704 Enrollment ID: I20101115000206 |
| Provider Name | Christina Renee Kopsick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629618806 PECOS PAC ID: 0345679494 Enrollment ID: I20200410002253 |
| Provider Name | Sabrina D Griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083258776 PECOS PAC ID: 8022435742 Enrollment ID: I20200826002500 |
| Provider Name | Shawna K Cribb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124780721 PECOS PAC ID: 3476945866 Enrollment ID: I20220114001044 |