Healthcare Provider Details

I. General information

NPI: 1275881211
Provider Name (Legal Business Name): GENTACARE HOME MEDICAL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PEACHTREE ST NE STE 400
ATLANTA GA
30303-1401
US

IV. Provider business mailing address

235 PEACHTREE ST NE STE 400
ATLANTA GA
30303-1401
US

V. Phone/Fax

Practice location:
  • Phone: 404-222-9909
  • Fax: 678-705-5661
Mailing address:
  • Phone: 404-222-9909
  • Fax: 678-705-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateGA
# 9
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. JEANETTA LAFREDA PAYNE
Title or Position: DIRECTOR OF NURSING
Credential: RN
Phone: 404-222-9909