Healthcare Provider Details

I. General information

NPI: 1013959147
Provider Name (Legal Business Name): JOHNSON COUNTY LTC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SMITH LN
ADRIAN GA
31002-4820
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 Code314000000X
TaxonomySkilled Nursing Facility
License Number1-083-1902
License Number StateGA

VIII. Authorized Official

Name: BECKY BROWNING
Title or Position: ADMINISTRATOR
Credential:
Phone: 478-668-3225