Healthcare Provider Details

I. General information

NPI: 1518139179
Provider Name (Legal Business Name): GARNER DAMIAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9063 RIVER BEND CT
VILLA RICA GA
30180-4155
US

IV. Provider business mailing address

PO BOX 911
WINSTON GA
30187-0911
US

V. Phone/Fax

Practice location:
  • Phone: 678-478-3730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number048R0418
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number048R0418
License Number StateGA

VIII. Authorized Official

Name: DAMIAN LAMOND GARNER
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential:
Phone: 678-478-3730