Provider Demographics
NPI:1376789628
Name:HOPE COTTAGE FAMILY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HOPE COTTAGE FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:229-726-9900
Mailing Address - Street 1:3025 BRECKINRIDGE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4979
Mailing Address - Country:US
Mailing Address - Phone:678-226-0082
Mailing Address - Fax:
Practice Address - Street 1:201 N CUTHBERT ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3518
Practice Address - Country:US
Practice Address - Phone:229-726-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1053165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty