Active NPI
Primary Medical Homecare LLC
- Home Health Agency
- Marietta, GA
National Provider Identifier
1043828932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- PRIMARY MEDICAL HOMECARE LLC
- Practice address
- 2480 Windy Hill Rd SE Ste 206
Marietta, GA 30067-8656 - Phone
- (404) 800-5550
- NPI assigned
- Jul 17, 2020
- Organization subpart
- Yes
- Parent organization
- PRIMARY MEDICAL HOMECARE 'PMH' LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Reda Coston, PSY.D/PH.D
- Title
- Healthcare Administrator
- Phone
- (404) 800-5550
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 11
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | |||
| Case Management Registered Nurse | 163WC0400X | |||
| Lodging Provider | 177F00000X | |||
| Case Management Agency | 251B00000X | |||
| Home Health Agency | 251E00000X | Primary | ||
| Home Infusion Agency | 251F00000X | |||
| Nursing Care Agency | 251J00000X | |||
| In Home Supportive Care Agency | 253Z00000X | |||
| Clinical Medical Laboratory | 291U00000X | |||
| Private Vehicle | 347C00000X | |||
| Technician | 374700000X |
Addresses
Primary practice location
2480 Windy Hill Rd SE Ste 206
Marietta, GA 30067-8656
Mailing address
2480 Windy Hill Rd SE Ste 206
Marietta, GA 30067-8656
Phone (404) 800-5550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 033-R-1687 | Other | GA | DEPT. OF COMMUNITY HEALTH |
National Provider Directory
National Provider Directory- Part of
- Primary Medical Homecare LLC
Locations
2480 Windy Hill Rd SE
Ste 206
Marietta, GA 30067
Phone (404) 800-5550
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Public Health & General Preventive Medicine Physician
- Marietta, GA
- NPI 1235464561
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594944000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1594944000000",
"number": "1043828932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2480 WINDY HILL RD SE STE 206",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300678656",
"telephone_number": "404-800-5550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2480 WINDY HILL RD SE STE 206",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300678656",
"telephone_number": "404-800-5550"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRIMARY MEDICAL HOMECARE LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PRIMARY MEDICAL HOMECARE 'PMH' LLC",
"enumeration_date": "2020-07-17",
"last_updated": "2020-07-17",
"certification_date": "2020-07-17",
"status": "A",
"authorized_official_last_name": "COSTON",
"authorized_official_first_name": "REDA",
"authorized_official_title_or_position": "HEALTHCARE ADMINISTRATOR",
"authorized_official_telephone_number": "404-800-5550",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PSY.D/PH.D"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Pastoral",
"state": null,
"license": null,
"primary": false
},
{
"code": "163WC0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Registered Nurse, Case Management",
"state": null,
"license": null,
"primary": false
},
{
"code": "177F00000X",
"taxonomy_group": "",
"desc": "Lodging",
"state": null,
"license": null,
"primary": false
},
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": false
},
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "251F00000X",
"taxonomy_group": "",
"desc": "Home Infusion",
"state": null,
"license": null,
"primary": false
},
{
"code": "251J00000X",
"taxonomy_group": "",
"desc": "Nursing Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": false
},
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": null,
"license": null,
"primary": false
},
{
"code": "374700000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT. OF COMMUNITY HEALTH",
"identifier": "033-R-1687",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.