Provider Demographics
NPI:1881495646
Name:SYNERGY HOMECARE OF FAYETTEVILLE GA LLC
Entity type:Organization
Organization Name:SYNERGY HOMECARE OF FAYETTEVILLE GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUNTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-352-0524
Mailing Address - Street 1:165 KEATON DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-2035
Mailing Address - Country:US
Mailing Address - Phone:470-352-0524
Mailing Address - Fax:
Practice Address - Street 1:288 HIGH WAY 314
Practice Address - Street 2:SUITE C
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:470-352-0524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOKUA COMMUNITY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies