Healthcare Provider Details

I. General information

NPI: 1629055199
Provider Name (Legal Business Name): WESLEY WOODS LONG TERM HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 CLIFTON RD NE
ATLANTA GA
30329-4021
US

IV. Provider business mailing address

1364 CLIFTON RD NE ROOM HB48
ATLANTA GA
30322-1064
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-7041
  • Fax: 404-712-5731
Mailing address:
  • Phone: 404-686-7041
  • Fax: 404-712-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number044-529
License Number StateGA

VIII. Authorized Official

Name: MR. JIMMY T HATCHER
Title or Position: CFO EMORY HEALTHCARE
Credential:
Phone: 404-686-2983