Healthcare Provider Details

I. General information

NPI: 1083531289
Provider Name (Legal Business Name): GRACE'S HOUSE TWO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RAINTREE DR SE
SILVER CREEK GA
30173-2616
US

IV. Provider business mailing address

5 RAINTREE DR SE
SILVER CREEK GA
30173-2616
US

V. Phone/Fax

Practice location:
  • Phone: 706-295-7084
  • Fax:
Mailing address:
  • Phone: 706-295-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: THOMAS R WILLIAMS
Title or Position: OWNER
Credential:
Phone: 706-295-7084