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Organization
BETTIS AFFINITY
Active
Organization
BETTIS AFFINITY
Active
Other names
HOMEWATCH CAREGIVERS OF KENNESAW
Organization subpart
No
Provider details
NPI number
Authorized official
ENID CHERISE PARKER BSN (CLINICAL MANAGER)
(678) 499-9703
Entity
Organization
Contact information
Practice address
3440 BLUE SPRINGS RD NW STE 103, KENNESAW, GA 30144-1035
(678) 956-8930
(678) 956-8930
Mailing address
3440 BLUE SPRINGS RD NW STE 103, KENNESAW, GA 30144-1035
(678) 956-8930
(678) 956-8930
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871057224
NON-MEDICARE
GA
05
—
1871057224
—
GA
Enumeration date
06/22/2020
Last updated
06/22/2020
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