Provider Demographics
NPI:1588658066
Name:ANGELS OF GWINNETT, INC.
Entity Type:Organization
Organization Name:ANGELS OF GWINNETT, INC.
Other - Org Name:ANGELS PERSONAL CARE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KATHERINA
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-272-8940
Mailing Address - Street 1:4038 CARTER DR NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2710
Mailing Address - Country:US
Mailing Address - Phone:770-638-7263
Mailing Address - Fax:770-638-8776
Practice Address - Street 1:4284 OAK CIR NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2625
Practice Address - Country:US
Practice Address - Phone:770-638-7263
Practice Address - Fax:770-638-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty