Provider Demographics
NPI:1518593946
Name:INNOVATIVE NURSING SOLUTIONS OF GEORGIA LLC
Entity Type:Organization
Organization Name:INNOVATIVE NURSING SOLUTIONS OF GEORGIA LLC
Other - Org Name:INNOVATIVE NURSING SOULTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVE-EDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-806-5949
Mailing Address - Street 1:1818 LAKEFIELD CT SE STE B
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6610
Mailing Address - Country:US
Mailing Address - Phone:678-806-5900
Mailing Address - Fax:678-203-2421
Practice Address - Street 1:1818 LAKEFIELD CT SE STE B
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6610
Practice Address - Country:US
Practice Address - Phone:678-806-5949
Practice Address - Fax:678-609-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care