Provider Demographics
NPI:1538793534
Name:ERA, ERNIA NECHELLE (HEALTH CARE OWNER)
Entity type:Individual
Prefix:
First Name:ERNIA
Middle Name:NECHELLE
Last Name:ERA
Suffix:
Gender:F
Credentials:HEALTH CARE OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11163 WIND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3754
Mailing Address - Country:US
Mailing Address - Phone:678-334-7298
Mailing Address - Fax:
Practice Address - Street 1:1557 LOVEJOY RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-1561
Practice Address - Country:US
Practice Address - Phone:678-334-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028865207251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA833780194Medicaid