Provider Demographics
NPI:1568793420
Name:GENESIS SPECIALTY HOME INFUSION THERAPY
Entity Type:Organization
Organization Name:GENESIS SPECIALTY HOME INFUSION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-935-3097
Mailing Address - Street 1:1065 MAYCROFT KNL
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7737
Mailing Address - Country:US
Mailing Address - Phone:404-935-3097
Mailing Address - Fax:678-609-1361
Practice Address - Street 1:1065 MAYCROFT KNL
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7737
Practice Address - Country:US
Practice Address - Phone:404-935-3097
Practice Address - Fax:678-609-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion