Healthcare Provider Details

I. General information

NPI: 1114914785
Provider Name (Legal Business Name): SMITH MEDICAL NURSING CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E MCCARTY ST
SANDERSVILLE GA
31082-2070
US

IV. Provider business mailing address

501 E MCCARTY ST
SANDERSVILLE GA
31082-2070
US

V. Phone/Fax

Practice location:
  • Phone: 478-552-5155
  • Fax: 478-552-0826
Mailing address:
  • Phone: 478-552-5155
  • Fax: 478-552-0826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1150258
License Number StateGA

VIII. Authorized Official

Name: JANICE THOMPSON
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 478-552-5155