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General NPI Number Information
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NPI Number | 1679137152
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Entity Type | Organization
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Legal Business Name | BLESSED GARDENZ LLC
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 1161 HACKNEE CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2771
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Country | US
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Telephone | 678-373-3900
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Fax | 678-373-3900
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Provider Business Mailing Address
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Address Line | 1161 HACKNEE CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2771
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Country | US
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Telephone | 678-373-3900
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Fax | 678-373-3900
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Authorized Official
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Title or Position | DIRECTOR
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Name | YABA PHILOMENE-B AWUAH
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Credential |
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Telephone | 404-547-5385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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