Active NPI
Jorge Caraballo
- Home Health Agency
- Powder Springs, GA
National Provider Identifier
1750753133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- OCC014925
- Practice address
- 5672 Harbormist Dr
Powder Springs, GA 30127-6963 - Phone
- (678) 997-4048
- NPI assigned
- Oct 26, 2015
- Last updated
- Oct 26, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | OCC014925 | GA | Primary |
Addresses
Primary practice location
5672 Harbormist Dr
Powder Springs, GA 30127-6963
Mailing address
PO Box 867
Powder Springs, GA 30127-6963
Phone (678) 997-4048
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OCC014925 | GA | MD | Home Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445817600000",
"number": "1750753133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 867",
"city": "POWDER SPRINGS",
"state": "GA",
"postal_code": "301276963",
"telephone_number": "678-997-4048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5672 HARBORMIST DR",
"city": "POWDER SPRINGS",
"state": "GA",
"postal_code": "301276963",
"telephone_number": "678-997-4048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARABALLO",
"first_name": "JORGE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-26",
"last_updated": "2015-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "GA",
"license": "OCC014925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Powder Springs, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.