Provider Demographics
NPI:1386079051
Name:GEORGIA SPECIALTY CARE STAFFING AGENCY LLC
Entity type:Organization
Organization Name:GEORGIA SPECIALTY CARE STAFFING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRYNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-412-1824
Mailing Address - Street 1:451 HAMPTON GREEN DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-7736
Mailing Address - Country:US
Mailing Address - Phone:706-412-1824
Mailing Address - Fax:
Practice Address - Street 1:451 HAMPTON GREEN DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-7736
Practice Address - Country:US
Practice Address - Phone:706-412-1824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care