Provider Demographics
NPI:1134740418
Name:DYNAMIC HOSPICE OF NORTH GEORGIA, INC.
Entity type:Organization
Organization Name:DYNAMIC HOSPICE OF NORTH GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-779-7685
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085-1303
Mailing Address - Country:US
Mailing Address - Phone:313-779-7685
Mailing Address - Fax:
Practice Address - Street 1:1558 MARIETTA HWY STE 210
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3615
Practice Address - Country:US
Practice Address - Phone:470-259-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based