Provider Demographics
NPI:1134931827
Name:ENGLERSTON HEALTH CORPORATION
Entity type:Organization
Organization Name:ENGLERSTON HEALTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARDSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMANGLES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:770-870-0337
Mailing Address - Street 1:29 BROOKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-1258
Mailing Address - Country:US
Mailing Address - Phone:260-479-0409
Mailing Address - Fax:949-703-8556
Practice Address - Street 1:7447 DOUGLAS BLVD STE 107F
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1575
Practice Address - Country:US
Practice Address - Phone:770-870-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No251E00000XAgenciesHome Health