Provider Demographics
NPI:1922235076
Name:DAY BREAK MEDICAL RESOURCE GROUP
Entity Type:Organization
Organization Name:DAY BREAK MEDICAL RESOURCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-267-5931
Mailing Address - Street 1:4349 WHITE PINE CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-8122
Mailing Address - Country:US
Mailing Address - Phone:706-267-5931
Mailing Address - Fax:
Practice Address - Street 1:4349 WHITE PINE CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-8122
Practice Address - Country:US
Practice Address - Phone:706-267-5931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN059308164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1720251812OtherTYPE UNKNOWN/ISSUED FOR US ARMY MEDICAL CENTER