Healthcare Provider Details

I. General information

NPI: 1336764802
Provider Name (Legal Business Name): GWINNETT CARE AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 EDENDERRY DR
SNELLVILLE GA
30039-5961
US

IV. Provider business mailing address

3585 EDENDERRY DR
SNELLVILLE GA
30039-5961
US

V. Phone/Fax

Practice location:
  • Phone: 617-480-9507
  • Fax:
Mailing address:
  • Phone: 617-480-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JULIENNE THOMAS
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 617-480-9507