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General NPI Number Information
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NPI Number | 1134931827
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Entity Type | Organization
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Legal Business Name | ENGLERSTON HEALTH CORPORATION
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 7447 DOUGLAS BLVD STE 107F
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1575
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Country | US
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Telephone | 770-870-0337
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Fax |
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Provider Business Mailing Address
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Address Line | 29 BROOKSTONE DR
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City | ACWORTH
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State | GA
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Zip | 30101-1258
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Country | US
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Telephone | 260-479-0409
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Fax | 949-703-8556
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. RICHARDSON DESMANGLES
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Credential | FNP-C
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Telephone | 770-870-0337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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