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General NPI Number Information
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NPI Number | 1821897042
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Entity Type | Individual
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Provider Name | ANDREW BOARD
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Gender | Male
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 8455 HIGHWAY 85 BLDG 200
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City | RIVERDALE
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State | GA
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Zip | 30274-5115
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Country | US
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Telephone | 619-708-7768
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Fax |
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Provider Business Mailing Address
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Address Line | 9898 VISTA CIR
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City | UNION CITY
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State | GA
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Zip | 30291-6022
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Country | US
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Telephone | 619-708-7768
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | CN0030089690
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License Number State | GA
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