Fundamental Health Group, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

FUNDAMENTAL HEALTH GROUP, LLC

Practice address

550 Peachtree St NE
Suite 1210
Atlanta, GA 30308-2237

Phone

(404) 856-7610

Fax

(866) 266-5030

NPI assigned

Aug 27, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Adam Jacob Fraser, CSA

Title

President

Phone

(404) 856-7610

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• BrightStar of NW Atlanta Doing business as

Locations

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

{
    "created_epoch": "1377561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432771200000",
    "number": "1588098529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE",
            "address_2": "SUITE 1210",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082237",
            "telephone_number": "404-856-7610",
            "fax_number": "866-266-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE",
            "address_2": "SUITE 1210",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082237",
            "telephone_number": "404-856-7610",
            "fax_number": "866-266-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDAMENTAL HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-27",
        "last_updated": "2015-05-28",
        "status": "A",
        "authorized_official_last_name": "FRASER",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "JACOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-856-7610",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CSA"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME CARE PROVIDER LICENSE - SKILLED NURSING, PERSONAL CARE, & COMPANION/SITTER",
            "identifier": "060-R-1213",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOINT COMMISSION ACCRED",
            "identifier": "563170",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFIED SENIOR ADVISOR",
            "identifier": "SCSA095804",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BrightStar of NW Atlanta",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• In Home Supportive Care Agency in Atlanta, GA
• Providers in Atlanta, GA by specialty
• In Home Supportive Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; 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.