Provider Demographics
NPI:1386316297
Name:GHOSN ELDERLY CARE
Entity type:Organization
Organization Name:GHOSN ELDERLY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-858-6179
Mailing Address - Street 1:73 PRESTIGE LN STE 103
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6370
Mailing Address - Country:US
Mailing Address - Phone:678-858-6179
Mailing Address - Fax:706-429-0033
Practice Address - Street 1:73 PRESTIGE LN STE 103
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6370
Practice Address - Country:US
Practice Address - Phone:678-858-6179
Practice Address - Fax:706-429-0033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GHOSN FAMILY MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-29
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty