Provider Demographics
NPI:1871370460
Name:HAGOS, HELINA
Entity type:Individual
Prefix:
First Name:HELINA
Middle Name:
Last Name:HAGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 HAMMOND DR UNIT 277
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5494
Mailing Address - Country:US
Mailing Address - Phone:470-728-6702
Mailing Address - Fax:
Practice Address - Street 1:1160 HAMMOND DR UNIT 277
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5494
Practice Address - Country:US
Practice Address - Phone:470-728-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23-103907342000000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No342000000XTransportation ServicesTransportation Network Company