Healthcare Provider Details

I. General information

NPI: 1417851130
Provider Name (Legal Business Name): SUMMER WILLOW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 NUNEZ LEXSY RD
SWAINSBORO GA
30401-5170
US

IV. Provider business mailing address

PO BOX 1314
SWAINSBORO GA
30401-1314
US

V. Phone/Fax

Practice location:
  • Phone: 912-562-4325
  • Fax:
Mailing address:
  • Phone: 912-562-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: SOPHIE VAUTIER
Title or Position: OWNER
Credential:
Phone: 478-206-5165