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DR. CORETTA D. GERVIN HEALTHCARE NPI 1467091629


NPI Information

NPI: 1467091629
Provider Name: DR. CORETTA D. GERVIN HEALTHCARE

Doing Business As: CDG HEALTHCARE PROVIDER, P.C.

Classification: Registered Nurse - 163WH0200X
Entity Type: Organization

Specialization: Home Health

Address:
414 N WESTOVER BLVD STE D1
ALBANY, GA
ZIP 31707
Phone: (404) 710-6646
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DR. CORETTA D. GERVIN HEALTHCARE is a home health registered nurse in Albany, GA. DR. CORETTA D. GERVIN HEALTHCARE NPI is 1467091629. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Cdg Healthcare Provider, P.c..

The provider's business location address is:

414 N WESTOVER BLVD STE D1
ALBANY, GA
ZIP 31707-102
Phone: (404) 710-6646
Fax: (229) 234-1391

The provider's authorized official is Coretta Delia Keith .
The authorized official title is Ceo and has the following contact phone number (404) 710-6646.

The enumeration date for this NPI number is 1/4/2020 and was last updated on 8/10/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse PractitionerNo
2163WH0200XRegistered NurseHome HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1003239804AMEDICAIDGEORGIA
2003239804BMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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