Organization
GEORGIA HEALTH SERVICES NETWORK, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN FAGAN (CEO ADMINISTRATOR)
(770) 466-7771
Entity
Organization
Contact information
Practice address
3234 HOLLY STAND CT, LOGANVILLE, GA 30052-3254
(770) 466-7771
(770) 466-3810
Mailing address
3234 HOLLY STAND CT, LOGANVILLE, GA 30052-3254
(770) 466-7771
(770) 466-3810
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
473089321A
—
GA
05
—
473089321B
—
GA
Enumeration date
12/13/2006
Last updated
05/26/2015
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