Provider Demographics
NPI:1124585005
Name:PROFESSIONAL NURSING ASSOCIATES OF GEORGIA LLC
Entity Type:Organization
Organization Name:PROFESSIONAL NURSING ASSOCIATES OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-682-4400
Mailing Address - Street 1:110 HABERSHAM DR STE 152
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1381
Mailing Address - Country:US
Mailing Address - Phone:678-582-9215
Mailing Address - Fax:
Practice Address - Street 1:110 HABERSHAM DR STE 152
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1381
Practice Address - Country:US
Practice Address - Phone:678-582-9215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care