Dr. Coretta D. Gervin Healthcare

Primary specialty

Home Health Registered NurseTaxonomy code 163WH0200X

Legal business name

DR. CORETTA D. GERVIN HEALTHCARE

Practice address

414 N Westover Blvd Ste D1
Albany, GA 31707-2102

Phone

(404) 710-6646

Fax

(229) 234-1391

NPI assigned

Jan 4, 2020

Organization subpart

Yes

Parent organization

CDG HEALTHCARE PROVIDER, P.C.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Coretta Delia Keith, DNP, FNP-BCNPI 1306884374

Title

Ceo

Phone

(404) 710-6646

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• CDG Healthcare Provider, P.C. Doing business as

Part of

Dr Coretta D Gervin Healthcare

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Coretta D. Keith, DNP, FNP-BC

  • Nurse Practitioner
  • Tifton, GA
  • NPI 1306884374
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1467091629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 N WESTOVER BLVD STE D1",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317072102",
            "telephone_number": "404-710-6466",
            "fax_number": "229-389-2573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 N WESTOVER BLVD STE D1",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317072102",
            "telephone_number": "404-710-6646",
            "fax_number": "229-234-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. CORETTA D. GERVIN HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CDG HEALTHCARE PROVIDER, P.C.",
        "enumeration_date": "2020-01-04",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "KEITH",
        "authorized_official_first_name": "CORETTA",
        "authorized_official_middle_name": "DELIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-710-6646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003239804A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003239804B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CDG Healthcare Provider, P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Registered Nurse in Albany, GA
• Providers in Albany, GA by specialty
• Home Health Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.