Healthcare Provider Details

I. General information

NPI: 1417113861
Provider Name (Legal Business Name): BNC MEDICAL INVESTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LAUREL ST
NASHVILLE GA
31639-3030
US

IV. Provider business mailing address

405 LAUREL ST
NASHVILLE GA
31639-3030
US

V. Phone/Fax

Practice location:
  • Phone: 229-543-7309
  • Fax: 229-543-1724
Mailing address:
  • Phone: 229-543-7309
  • Fax: 229-543-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES E. JABALEY
Title or Position: MEMBER
Credential:
Phone: 423-614-6747