DR. CORETTA D. GERVIN HEALTHCARE (NPI# 1467091629) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467091629 |
| Entity Type | Organization |
| Organization Name | DR. CORETTA D. GERVIN HEALTHCARE |
| Practice Address |
116 Beowulf Ln Leesburg GA 31763-5831 |
| Practice Telephone | 4047106646 |
| Practice Fax Number | 2294058570 |
| Mailing Telephone | 4047106646 |
| Mailing Fax Number | 2294058570 |
| Enumeration Date | 2020-01-04 |
| Last Update Date | 2020-01-04 |
| Authorized Official Name | DR. CORETTA DELIA KEITH (CEO) |
| Authorized Official Telephone | 4047106646 |
| Authorized Official Credential | DNP, FNP-BC |
| Is Organization Subpart | Y |
| Parent Organization Name | DR. CORETTA D. GERVIN HEALTHCARE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 163WH0200X |
Registered Nurse Specialization: Home Health |
Nursing Service Providers |
| Other Name | Type Code |
|---|---|
| Dr. Coretta D. Gervin Healthcare Provider, PC | Doing Business As Name - Organization |
| Street Address |
116 BEOWULF LN |
| City | LEESBURG |
| State | GA |
| Zip Code | 31763-5831 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790150423 | Jamie Perrella Flynn-pressley | Counselor | 112 Cris Ann St., Leesburg, GA 31763 | 2015-12-07 |
| 1023429511 | Brookstone Medical LLC | Durable Medical Equipment & Medical Supplies | 123 Hugh Rd, Leesburg, GA 31763 | 2014-05-19 |
| 1124370796 | Freds Stores of Tennessee Inc | Pharmacy | 118 Robert B Lee Drive, Leesburg, GA 31763 | 2012-10-08 |
| 1255649273 | Lee County Optical LLC | Optometrist | 1569 Highway 19 South, Leesburg, GA 31763 | 2010-09-24 |
| 1851572473 | Shaun Nicholas Price | Chiropractor | 152 Robert B Lee Dr, # 31, Leesburg, GA 31763 | 2007-11-26 |
| 1710042007 | Williams & Bush Partnership | Dentist | 919 Us Hwy 19 South, Leesburg, GA 31763 | 2006-12-27 |
| 1063570398 | Lee County Board of Education | Local Education Agency (LEA) | 126 Starksville Avenue, North, Leesburg, GA 31763 | 2006-12-06 |
| 1225109929 | Lee County School System | Local Education Agency (LEA) | 126 Starksville Avenue North, Leesburg, GA 31763 | 2006-11-13 |
| 1073682936 | Adams' Loving Pro Home Health Care Inc. | Home Health | 1277 Hwy 82 West, 121, Leesburg, GA 31763 | 2006-11-07 |
| 1225132699 | Deirdre Mae Clairewen Lawson | Internal Medicine | 235 Walnut Street, Leesburg, GA 31763 | 2006-09-07 |
| Find all providers in zip 31763 | ||||
| Taxonomy Code | 163WH0200X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Home Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548392525 | Karin V Blaquier | Registered Nurse | 310 Market St, Leesburg, FL 34748-5135 | 2007-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982205761 | Wee-care Georgia - Home Health-care | Registered Nurse | 3235 Satellite Blvd Ste 300, Duluth, GA 30096-8688 | 2020-11-06 |
| 1598372732 | Debbie Denise Lynch-berry | Registered Nurse | 475 Lory Ln, Grovetown, GA 30813-6104 | 2020-09-30 |
| 1922613611 | Chinyere Gloria Akpan | Registered Nurse | 147 Eagle Rock Dr, Acworth, GA 30101-1916 | 2020-09-10 |
| 1942812409 | Tehanya Michelle Peagler | Registered Nurse | 62 Saint Johns Rd, Hinesville, GA 31313-5837 | 2020-08-17 |
| 1215553649 | Kerry-ann Nicole Campbell | Registered Nurse | 1546 Riverview Rd, Monroe, GA 30655-4011 | 2020-06-22 |
| 1992327597 | Bridget Ronke Emeli-ba | Registered Nurse | 3334 Stone Mountain Hwy, Snellville, GA 30078-6840 | 2020-05-18 |
| 1407484322 | Domonque Louise Jakes | Registered Nurse | 4521 Saddle Bend Trl, Snellville, GA 30039-5984 | 2020-03-27 |
| 1740817717 | Ebenezer Ashitei | Registered Nurse | 3210 Christiana Cir Nw, Kennesaw, GA 30152-6985 | 2020-03-26 |
| 1285260778 | Global Wellness and Recovery LLC | Registered Nurse | 100 Blanket Pass, Covington, GA 30016-2319 | 2020-03-17 |
| 1336774256 | Qudus Olajire Ibiyemi | Registered Nurse | 4140 Woodcrest Ln, Powder Springs, GA 30127-2529 | 2020-03-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.