Provider Demographics
NPI:1588067144
Name:GENUINE HEALTHCARE OF GEORGIA, LLC
Entity type:Organization
Organization Name:GENUINE HEALTHCARE OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:OLYMPIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-834-2511
Mailing Address - Street 1:500 LANIER AVE W
Mailing Address - Street 2:SUITE 606B-10
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7636
Mailing Address - Country:US
Mailing Address - Phone:678-834-2511
Mailing Address - Fax:
Practice Address - Street 1:500 LANIER AVE W
Practice Address - Street 2:SUITE 606B-10
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7636
Practice Address - Country:US
Practice Address - Phone:678-834-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health