Organization
GENTIVA HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM STANFORD RN (PCM MANAGER)
(770) 383-3565
Entity
Organization
Contact information
Practice address
23 WESTOVER DRIVE NW, ADAIRSVILLE, GA 30103
(770) 383-3565
(770) 383-3566
Mailing address
34 CENTER RD, CARTERSVILLE, GA 30120
(770) 383-3565
(770) 383-3566
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
RN172144
GA
Other
Enumeration date
12/28/2011
Last updated
12/28/2011
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