Healthcare Provider Details

I. General information

NPI: 1376033548
Provider Name (Legal Business Name): GEORGINA PERRY BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 BALL AVE NE
GRAND RAPIDS MI
49503-1307
US

IV. Provider business mailing address

775 BALL AVE NE
GRAND RAPIDS MI
49503-1307
US

V. Phone/Fax

Practice location:
  • Phone: 616-632-7884
  • Fax: 616-632-7899
Mailing address:
  • Phone: 616-632-7884
  • Fax: 616-632-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: