Provider Demographics
NPI:1154687051
Name:GEROGIA METROPOLITAN HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:GEROGIA METROPOLITAN HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DORVILUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-279-2162
Mailing Address - Street 1:3912 SUWANEE MILL DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8745
Mailing Address - Country:US
Mailing Address - Phone:770-837-1302
Mailing Address - Fax:
Practice Address - Street 1:3912 SUWANEE MILL DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8745
Practice Address - Country:US
Practice Address - Phone:770-837-1302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067 R 0682251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health