Provider Demographics
NPI:1770847725
Name:GEORGIA SPECIALTY CARE STAFFING AGENCY
Entity Type:Organization
Organization Name:GEORGIA SPECIALTY CARE STAFFING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRYNA
Authorized Official - Middle Name:DELMARA
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-756-9510
Mailing Address - Street 1:307 S LEWIS ST STE C
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3169
Mailing Address - Country:US
Mailing Address - Phone:706-756-9510
Mailing Address - Fax:
Practice Address - Street 1:307 S LEWIS ST STE C
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3169
Practice Address - Country:US
Practice Address - Phone:706-756-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care