Healthcare Provider Details

I. General information

NPI: 1114056934
Provider Name (Legal Business Name): FOUR COUNTY HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 OVERBY DR
RICHLAND GA
31825-1322
US

IV. Provider business mailing address

PO BOX 339
RICHLAND GA
31825-0339
US

V. Phone/Fax

Practice location:
  • Phone: 229-887-2021
  • Fax: 229-887-3978
Mailing address:
  • Phone: 229-887-2021
  • Fax: 229-887-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1-128-1712
License Number StateGA

VIII. Authorized Official

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