Healthcare Provider Details

I. General information

NPI: 1679156616
Provider Name (Legal Business Name): GEORGIA NP HOUSE CALLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 PINE FOREST CT
JONESBORO GA
30236-5417
US

IV. Provider business mailing address

2007 PINE FOREST CT
JONESBORO GA
30236-5417
US

V. Phone/Fax

Practice location:
  • Phone: 678-923-1807
  • Fax:
Mailing address:
  • Phone: 678-923-1807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERRI T. VAN DORN
Title or Position: OWNER OPERATOR
Credential: ACNP-C
Phone: 678-923-1807