MEDICARE: HEALING OAKS LLC

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	261QP2300X	Primary Care Clinic/Center

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	:	1649856493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING OAKS LLC

Provider Business Mailing Address
First Line	:	PO BOX 5554
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-0290
Country	:	US
Telephone Number	:	770-378-0328
Fax Number	:	770-604-1929

Provider Business Practice Location Address
First Line	:	203 OAKSIDE LN STE C
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-6407
Country	:	US
Telephone Number	:	770-604-1930
Fax Number	:	770-604-1929

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	SHERYL B VICKERY
Credential	:	MD
Telephone Number	:	770-378-0328

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	03/22/2021

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Directions to “HEALING OAKS LLC ” Practice Location

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