Healthcare Provider Details

I. General information

NPI: 1912034745
Provider Name (Legal Business Name): LILLIAN G. CARTER NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HOSPITAL ST
PLAINS GA
31780-5544
US

IV. Provider business mailing address

225 HOSPITAL ST
PLAINS GA
31780-5544
US

V. Phone/Fax

Practice location:
  • Phone: 229-824-7796
  • Fax: 229-824-7800
Mailing address:
  • Phone: 229-824-7796
  • Fax: 229-824-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1-129-1714
License Number StateGA

VIII. Authorized Official

Name: KIM SHEFFIELD
Title or Position: VP OF FINANCIAL REPORTING
Credential:
Phone: 478-621-2100