Provider Demographics
NPI:1649958109
Name:GIDDENS DEVELOPMENT GROUP, LLC
Entity type:Organization
Organization Name:GIDDENS DEVELOPMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDDENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-599-2066
Mailing Address - Street 1:2400 HERODIAN WAY SE STE 340
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8506
Mailing Address - Country:US
Mailing Address - Phone:770-599-2066
Mailing Address - Fax:770-580-1612
Practice Address - Street 1:2400 HERODIAN WAY SE STE 340
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8506
Practice Address - Country:US
Practice Address - Phone:770-599-2066
Practice Address - Fax:770-580-1612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIDDENS DEVELOPMENT GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care