Professional Nursing Services of NA, LTD

Primary specialty

Home Health Registered NurseTaxonomy code 163WH0200X

License

158 R 0001 Issued in GA

Legal business name

PROFESSIONAL NURSING SERVICES OF NA, LTD

Practice address

107 Jackson St
Gordon, GA 31031-3908

Phone

(478) 628-5790

Fax

(478) 628-2954

NPI assigned

Nov 30, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. E Edwin Lavender

Title

Ceo

Phone

(478) 628-5790

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1548337694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67",
            "city": "GORDON",
            "state": "GA",
            "postal_code": "310310067",
            "telephone_number": "478-628-5790",
            "fax_number": "478-628-2954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 JACKSON ST",
            "city": "GORDON",
            "state": "GA",
            "postal_code": "310313908",
            "telephone_number": "478-628-5790",
            "fax_number": "478-628-2954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL NURSING SERVICES OF NA, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAVENDER",
        "authorized_official_first_name": "E",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "478-628-5790",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "GA",
            "license": "158 R 0001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.