=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598431215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BINDRABAN NARINE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2021
-----------------------------------------------------
Last Update Date | 09/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3021 HARRIS RD
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30060-3006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-293-2067
-----------------------------------------------------
Fax | 678-293-2067
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4966 DAY LILY WAY NW
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30102-8114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-401-7629
-----------------------------------------------------
Fax | 678-401-7629
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | PHCP011195
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | PHCP011195
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------