MEDICARE: WESLEY WOODS LONG TERM HOSPITAL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282E00000X	Long Term Care Hospital	044-529	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629055199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESLEY WOODS LONG TERM HOSPITAL, INC

Provider Business Mailing Address
First Line	:	1364 CLIFTON RD NE
Second Line	:	ROOM HB48
City	:	ATLANTA
State	:	GA
Zip	:	30322-1064
Country	:	US
Telephone Number	:	404-686-7041
Fax Number	:	404-712-5731

Provider Business Practice Location Address
First Line	:	1821 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-4021
Country	:	US
Telephone Number	:	404-686-7041
Fax Number	:	404-712-5731

Authorized Official
Title or Position	:	CFO EMORY HEALTHCARE
Name	:	MR. JIMMY T HATCHER
Credential	:
Telephone Number	:	404-686-2983

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	08/09/2011

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