# PROFESSIONAL NURSING SERVICES OF NA, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548337694
- **Authorized official:** MR. E EDWIN LAVENDER (CEO)
- **Authorized official phone:** (478) 628-5790

## Contact information

- **Practice address:** 107 JACKSON ST, GORDON, GA 31031-3908
- **Practice address phone:** (478) 628-5790
- **Practice address fax:** (478) 628-2954
- **Mailing address:** PO BOX 67, GORDON, GA 31031-0067
- **Mailing address phone:** (478) 628-5790
- **Mailing address fax:** (478) 628-2954

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | 158 R 0001 | GA | Yes |

## Other

- **Enumeration date:** 11/30/2006
- **Last updated:** 08/22/2020