Provider Demographics
NPI:1740013168
Name:A DEDICATED NURSE HEALTH SYSTEMS
Entity type:Organization
Organization Name:A DEDICATED NURSE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMELIA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:813-900-9900
Mailing Address - Street 1:863 FLAT SHOALS RD SE STE 232
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6633
Mailing Address - Country:US
Mailing Address - Phone:404-844-8019
Mailing Address - Fax:
Practice Address - Street 1:863 FLAT SHOALS RD SE STE 232
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6633
Practice Address - Country:US
Practice Address - Phone:404-844-8019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health