Healthcare Provider Details

I. General information

NPI: 1780621664
Provider Name (Legal Business Name): HEALTHMONT OF GEORGIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W 4TH ST
ADEL GA
31620-2607
US

IV. Provider business mailing address

706 N PARRISH AVE
ADEL GA
31620-1511
US

V. Phone/Fax

Practice location:
  • Phone: 229-896-8177
  • Fax: 229-896-7880
Mailing address:
  • Phone: 229-896-8177
  • Fax: 229-896-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number037-101
License Number StateGA

VIII. Authorized Official

Name: STACY WEEKS
Title or Position: DIRECTOR
Credential: R.N.
Phone: 229-896-8177