Healthcare Provider Details

I. General information

NPI: 1477681997
Provider Name (Legal Business Name): JOHNSON COUNTY NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SCHOOL STREET
ADRIAN GA
31002
US

IV. Provider business mailing address

PO BOX 287
ADRIAN GA
31002-0287
US

V. Phone/Fax

Practice location:
  • Phone: 478-668-3225
  • Fax: 478-668-3927
Mailing address:
  • Phone: 478-668-3225
  • Fax: 478-668-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1-083-1775
License Number StateGA

VIII. Authorized Official

Name: KIM SHEFFIELD
Title or Position: VP OF FINANCIAL REPORTING
Credential:
Phone: 478-621-2100