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General NPI Number Information
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NPI Number | 1215245634
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Entity Type | Organization
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Legal Business Name | GINPEN, LLC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 238 OLD NORTON RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-4921
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Country | US
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Telephone | 770-714-4643
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Fax |
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Provider Business Mailing Address
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Address Line | 238 OLD NORTON RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-4921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ANGELA SWAYNE
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Credential | MD
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Telephone | 770-714-4643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 053421
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License Number State | GA
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