Healthcare Provider Details

I. General information

NPI: 1710688494
Provider Name (Legal Business Name): MGHP-LILLIAN CARTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
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:
Mailing address:
  • Phone: 229-824-7796
  • Fax:

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: DAVID A PARKER
Title or Position: MEMBER OF LLC
Credential:
Phone: 678-480-7564