Healthcare Provider Details

I. General information

NPI: 1114128998
Provider Name (Legal Business Name): DESTINY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GREENBRIAR CT
SAVANNAH GA
31419-2956
US

IV. Provider business mailing address

155 GREENBRIAR CT
SAVANNAH GA
31419-2956
US

V. Phone/Fax

Practice location:
  • Phone: 912-961-5640
  • Fax: 912-961-5637
Mailing address:
  • Phone: 912-961-5640
  • Fax: 912-961-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SHARON W ASKEW
Title or Position: NURSE RN
Credential: CEO NURSE RN
Phone: 912-355-8750