Demetrius Battle

Individual provider Active NPI Foster Care Agency · Lawrenceville, GA

NPI 1487076733 · NPPES record last updated Jan 6, 2014

Key facts

NPI
1487076733
Entity type
Individual (NPI type 1)
Primary specialty
Foster Care Agency 253J00000X
License
45-4567251 (GA)
Practice address
840 Gateshead LN
Lawrenceville, GA 30043-6668
Phone
(770) 558-9596
NPI assigned
Jan 6, 2014
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
45-4567251GAMDFoster Care Agency

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Foster Care Agency 253J00000X 45-4567251 GA Yes

Addresses

Primary practice location

840 Gateshead LN
Lawrenceville, GA 30043-6668

Mailing address

840 Gateshead LN
Lawrenceville, GA 30043-6668
Phone (770) 558-9596

Other providers in Lawrenceville, GA

All providers in Lawrenceville, GA · Foster Care Agency in Georgia

Sources for this page

Verify at the official NPI Registry.