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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