Healthcare Provider Details

I. General information

NPI: 1366963019
Provider Name (Legal Business Name): SUMMERSET ASSISTED LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 BENJAMIN E MAYS DR SW
ATLANTA GA
30331-8600
US

IV. Provider business mailing address

3711 BENJAMIN E MAYS DR SW
ATLANTA GA
30331-8600
US

V. Phone/Fax

Practice location:
  • Phone: 404-691-4545
  • Fax: 866-384-4420
Mailing address:
  • Phone: 404-691-4545
  • Fax: 866-384-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberALC000041
License Number StateGA

VIII. Authorized Official

Name: MR. JULIUS M WILLIS SR.
Title or Position: PRESIDENT/CEO
Credential:
Phone: 404-691-4545