Healthcare Provider Details

I. General information

NPI: 1275464141
Provider Name (Legal Business Name): GREEN ACRES HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 LAYTON DR
LITHIA SPRINGS GA
30122-7902
US

IV. Provider business mailing address

4860 LAYTON DR
LITHIA SPRINGS GA
30122-7902
US

V. Phone/Fax

Practice location:
  • Phone: 706-804-1196
  • Fax:
Mailing address:
  • Phone: 706-804-1196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CORNEILLE A ADANOU
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-804-1196