Provider Demographics
NPI:1699159632
Name:GENESIS GLOBAL BUSINESS DEVELOPMENT, LLC
Entity type:Organization
Organization Name:GENESIS GLOBAL BUSINESS DEVELOPMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-458-8486
Mailing Address - Street 1:PO BOX 81461
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30366-1461
Mailing Address - Country:US
Mailing Address - Phone:404-458-8486
Mailing Address - Fax:404-480-8699
Practice Address - Street 1:4947 WINTERVIEW LN
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1992
Practice Address - Country:US
Practice Address - Phone:404-458-8486
Practice Address - Fax:404-480-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251J00000X, 253Z00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No347C00000XTransportation ServicesPrivate Vehicle