Country Air Villa LLC

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

COUNTRY AIR VILLA LLC

Practice address

8835 Northcutt Rd
Fairburn, GA 30213-2278

Phone

(404) 769-2963

Fax

(770) 964-5565

NPI assigned

Nov 13, 2020

Last updated

Nov 13, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrea Cargill

Title

Administrator

Phone

(404) 769-2963

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1093317000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8835 NORTHCUTT RD",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302132278",
            "telephone_number": "404-769-2963",
            "fax_number": "770-964-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8835 NORTHCUTT RD",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302132278",
            "telephone_number": "404-769-2963",
            "fax_number": "770-964-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY AIR VILLA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-13",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "CARGILL",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "404-769-2963"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nursing Care Agency in Fairburn, GA
• Providers in Fairburn, GA by specialty
• Nursing Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.

Verify at the official NPI Registry.