Provider Demographics
NPI:1376033548
Name:PERRY, GEORGINA (BSW)
Entity Type:Individual
Prefix:MRS
First Name:GEORGINA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 BALL AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1307
Mailing Address - Country:US
Mailing Address - Phone:616-632-7884
Mailing Address - Fax:616-632-7899
Practice Address - Street 1:775 BALL AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1307
Practice Address - Country:US
Practice Address - Phone:616-632-7884
Practice Address - Fax:616-632-7899
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator