Affinity Care of Georgia LLC
Organization Active NPI Community Based Hospice Care Agency · Atlanta, GA
NPI 1154030856 · NPPES record last updated Jun 9, 2026
Key facts
- NPI
- 1154030856
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- AFFINITY CARE OF GEORGIA LLC
- Practice address
- 2751 Buford Hwy NE Ste 285
Atlanta, GA 30324-5488 - Phone
- (510) 499-9977
- NPI assigned
- Nov 21, 2022
- Organization subpart
- No
Authorized official
- Name
- Samuel Stern
- Title
- Ceo
- Phone
- (510) 499-9977
Owners & managing parties with NPI records 1
-
Lee Wilkes, MD
Affiliated clinicians 2
-
Amit K Dua, M.D.
-
Anjali C Dua, M.D.
Medicare Care Compare: Hospice
- Listed as
- Affinity Care of Georgia, LLC
- Certified
- Nov 22, 2023
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2272786 | Affinity Care of Georgia LLC | Certificate of waiver | Nov 28, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Hospice certification: CCN 851587
- Legal name
- AFFINITY CARE OF GEORGIA LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Nov 22, 2023
- Last certification
- Feb 21, 2024
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 11, 2022 in GA
- Enrollment address
- 2751 Buford Hwy NE
Ste 285
Atlanta, GA 30324-5488
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Samuel Stern |
Contracted Managing Employee |
Nov 11, 2022 | |
| Corporate Officer |
Nov 11, 2022 | ||
| Corporate Director |
Nov 11, 2022 | ||
| Operational/Managerial Control |
Nov 11, 2022 | ||
| Starco of Georgia LLC |
5% Or Greater Direct Ownership Interest | Nov 11, 2022 | 60% |
| Operational/Managerial Control | Nov 11, 2022 | ||
| Georgia Hospice LLC |
5% Or Greater Direct Ownership Interest | Nov 11, 2022 | 40% |
| Lee Wilkes |
W-2 Managing Employee |
Oct 9, 2023 | |
| Jordan King |
W-2 Managing Employee |
Oct 9, 2023 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230718003236 | GA | Part a Provider - Hospice | 0941660229 | Practice locations: Watkinsville, GA; Atlanta, GA |
National Provider Directory
Locations
2751 Buford Hwy NE
Ste 285
Atlanta, GA 30324
Phone (770) 525-5550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Family Medicine) Physician |
207QH0002X | |||
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
2751 Buford Hwy NE Ste 285
Atlanta, GA 30324-5488
Mailing address
78 Opal St
Cartersville, GA 30120-2848
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All providers in Atlanta, GA · Community Based Hospice Care Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.