Provider Demographics
NPI:1083990501
Name:GEORGIA GIFTS FROM GRACE LLC
Entity Type:Organization
Organization Name:GEORGIA GIFTS FROM GRACE LLC
Other - Org Name:GEORGIA GIFTS FROM GRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:PO BOX 741908
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1908
Mailing Address - Country:US
Mailing Address - Phone:770-622-5889
Mailing Address - Fax:770-622-5890
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:770-622-5889
Practice Address - Fax:770-622-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
202G702021Medicare PIN