Provider Demographics
NPI:1750907184
Name:BETTIS AFFINITY
Entity type:Organization
Organization Name:BETTIS AFFINITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ENID
Authorized Official - Middle Name:CHERISE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:678-499-9703
Mailing Address - Street 1:3440 BLUE SPRINGS RD NW STE 103
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1035
Mailing Address - Country:US
Mailing Address - Phone:678-956-8930
Mailing Address - Fax:678-956-8930
Practice Address - Street 1:3440 BLUE SPRINGS RD NW STE 103
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1035
Practice Address - Country:US
Practice Address - Phone:678-956-8930
Practice Address - Fax:678-956-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1871057224Medicaid
GA1871057224OtherNON-MEDICARE