Provider Demographics
NPI:1073774105
Name:HOUSE CALLS OF NW GEORGIA, LLC
Entity Type:Organization
Organization Name:HOUSE CALLS OF NW GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:706-266-4387
Mailing Address - Street 1:30 WARD MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30145
Mailing Address - Country:US
Mailing Address - Phone:706-266-4387
Mailing Address - Fax:706-291-7383
Practice Address - Street 1:30 WARD MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:GA
Practice Address - Zip Code:30145-1129
Practice Address - Country:US
Practice Address - Phone:076-266-4387
Practice Address - Fax:706-291-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069392363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty