=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518139179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARNER DAMIAN, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2008
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9063 RIVER BEND CT
-----------------------------------------------------
City | VILLA RICA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30180-4155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-478-3730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 911
-----------------------------------------------------
City | WINSTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30187-0911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DAMIAN LAMOND GARNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-478-3730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 048R0418
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 048R0418
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------