Provider Demographics
NPI:1003121914
Name:DOVE HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:DOVE HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AKAMBA
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:ETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-545-1295
Mailing Address - Street 1:6659 MORNING DOVE PL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1319
Mailing Address - Country:US
Mailing Address - Phone:678-545-1295
Mailing Address - Fax:770-472-8998
Practice Address - Street 1:6659 MORNING DOVE PL
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1319
Practice Address - Country:US
Practice Address - Phone:678-545-1295
Practice Address - Fax:770-472-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-R-0363251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA371443418AMedicaid
GA031-R-0363OtherGEORGIA DEPARTMENT OF COMMUNITY HEALTH