Mudaris Healthcare LLC

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

MUDARIS HEALTHCARE LLC

Practice address

4590 Valley Pkwy SE Apt E
Smyrna, GA 30082-4981

Phone

(646) 420-3010

NPI assigned

Jun 9, 2025

Organization subpart

No

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

Authorized official

Name

Andre Derricotte

Title

Director

Phone

(646) 420-3010

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1275428484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 RIDENOUR BLVD NW STE 100",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524528",
            "telephone_number": "470-995-1258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4590 VALLEY PKWY SE APT E",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300824981",
            "telephone_number": "646-420-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUDARIS HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A",
        "authorized_official_last_name": "DERRICOTTE",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "646-420-3010"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.