Organization
DR. CORETTA D. GERVIN HEALTHCARE
Active
Parent organization
CDG HEALTHCARE PROVIDER, P.C.
Other names
CDG Healthcare Provider, P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CDG HEALTHCARE PROVIDER, P.C.
Authorized official
DR. CORETTA DELIA KEITH DNP, FNP-BC (CEO)
(404) 710-6646
Entity
Organization
Contact information
Practice address
414 N WESTOVER BLVD STE D1, ALBANY, GA 31707-2102
(404) 710-6646
(229) 234-1391
Mailing address
414 N WESTOVER BLVD STE D1, ALBANY, GA 31707-2102
(404) 710-6466
(229) 389-2573
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003239804A
—
GA
05
—
003239804B
—
GA
Enumeration date
01/04/2020
Last updated
08/10/2023
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