Provider Demographics
NPI:1699390690
Name:GAMBLE, GEORGIA (HHA)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-1115
Mailing Address - Country:US
Mailing Address - Phone:513-802-3766
Mailing Address - Fax:
Practice Address - Street 1:3629 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1115
Practice Address - Country:US
Practice Address - Phone:513-802-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty