Provider Demographics
NPI:1710615075
Name:A GOLDEN EXPERIENCE
Entity Type:Organization
Organization Name:A GOLDEN EXPERIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAQUANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINCE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-386-7927
Mailing Address - Street 1:3200 N HENRY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4666
Mailing Address - Country:US
Mailing Address - Phone:770-376-6927
Mailing Address - Fax:770-727-7024
Practice Address - Street 1:3200 N HENRY BLVD STE C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4666
Practice Address - Country:US
Practice Address - Phone:770-376-6927
Practice Address - Fax:770-727-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003240710AMedicaid