Organization
TALENT SQUAD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA GIBSON (MANAGER)
(470) 885-8500
Entity
Organization
Contact information
Practice address
4004 CASTLE WAY, FAIRBURN, GA 30213-4712
(470) 885-8500
Mailing address
4004 CASTLE WAY, FAIRBURN, GA 30213-4712
(470) 885-8500
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
08/25/2020
Last updated
08/25/2020
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