Provider Demographics
NPI:1447282066
Name:TALLAPOOSA HOME CARE CO
Entity type:Organization
Organization Name:TALLAPOOSA HOME CARE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/C.O.O
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CO, LO
Authorized Official - Phone:404-538-5921
Mailing Address - Street 1:1031 CAMBRIDGE SQ STE A
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1869
Mailing Address - Country:US
Mailing Address - Phone:770-574-9126
Mailing Address - Fax:888-501-6340
Practice Address - Street 1:1031 CAMBRIDGE SQ STE A
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1869
Practice Address - Country:US
Practice Address - Phone:770-574-9126
Practice Address - Fax:888-501-6340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA798679525AMedicaid
GA5044740001Medicare ID - Type Unspecified