Healthcare Provider Details

I. General information

NPI: 1447875307
Provider Name (Legal Business Name): GEORGIA PALLIATIVE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 CEDARCREST RD STE 120
ACWORTH GA
30101-8928
US

IV. Provider business mailing address

3660 CEDARCREST RD STE 120
ACWORTH GA
30101-8928
US

V. Phone/Fax

Practice location:
  • Phone: 770-599-2477
  • Fax: 678-324-0548
Mailing address:
  • Phone: 770-599-2477
  • Fax: 678-324-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DURIEL GRAY
Title or Position: OWNER
Credential: MD
Phone: 770-599-2477