MEDICARE: GENTLE GIANT CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1578136156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE GIANT CARE

Provider Business Mailing Address
First Line	:	600 PHIPPS BLVD NE APT 1601
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3345
Country	:	US
Telephone Number	:	803-394-4993
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 PHIPPS BLVD NE APT 1601
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3345
Country	:	US
Telephone Number	:	803-394-4993
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LEQUAWN M JAMES
Credential	:	NP
Telephone Number	:	803-394-4993

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	07/21/2021

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