Provider Demographics
NPI:1821350307
Name:DAGGS, GEORGIA CAROLE (LVN)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:CAROLE
Last Name:DAGGS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-0093
Mailing Address - Country:US
Mailing Address - Phone:510-485-1390
Mailing Address - Fax:
Practice Address - Street 1:3133 38TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1259
Practice Address - Country:US
Practice Address - Phone:510-485-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173020164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse