Provider Demographics
NPI:1154453736
Name:GENESIS HEALTHCARE ASSOCIATES PC
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:NEAL-HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-434-1662
Mailing Address - Street 1:3200 HIGHLANDS PARKWAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082
Mailing Address - Country:US
Mailing Address - Phone:770-434-1662
Mailing Address - Fax:770-434-1304
Practice Address - Street 1:3200 HIGHLANDS PARKWAY
Practice Address - Street 2:SUITE 250
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082
Practice Address - Country:US
Practice Address - Phone:770-434-1662
Practice Address - Fax:770-434-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00744279VMedicaid
11SCGWSMedicare ID - Type Unspecified