# DR. CORETTA D. GERVIN HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CDG HEALTHCARE PROVIDER, P.C.
- **Other names:** CDG Healthcare Provider, P.C.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1467091629
- **Legal business name:** CDG HEALTHCARE PROVIDER, P.C.
- **Authorized official:** DR. CORETTA DELIA KEITH DNP, FNP-BC (CEO)
- **Authorized official phone:** (404) 710-6646

## Contact information

- **Practice address:** 414 N WESTOVER BLVD STE D1, ALBANY, GA 31707-2102
- **Practice address phone:** (404) 710-6646
- **Practice address fax:** (229) 234-1391
- **Mailing address:** 414 N WESTOVER BLVD STE D1, ALBANY, GA 31707-2102
- **Mailing address phone:** (404) 710-6466
- **Mailing address fax:** (229) 389-2573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | — | NULL | Yes |
| 163WH0200X | Home Health Registered Nurse | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/04/2020
- **Last updated:** 08/10/2023