Healthcare Provider Details

I. General information

NPI: 1992799860
Provider Name (Legal Business Name): PUTNAM COUNTY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SPARTA HWY
EATONTON GA
31024-6093
US

IV. Provider business mailing address

125 SPARTA HIGHWAY
EATONTON GA
31024
US

V. Phone/Fax

Practice location:
  • Phone: 706-485-8573
  • Fax: 706-485-8283
Mailing address:
  • Phone: 706-485-8573
  • Fax: 706-485-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-117-1769
License Number StateGA

VIII. Authorized Official

Name: TIMOTHY GAINT
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-485-8573