Healthcare Provider Details

I. General information

NPI: 1609194901
Provider Name (Legal Business Name): THE GILEAD GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 GREENWAY ST
THOMSON GA
30824-2723
US

IV. Provider business mailing address

PO BOX 565
THOMSON GA
30824-0565
US

V. Phone/Fax

Practice location:
  • Phone: 706-597-1890
  • Fax:
Mailing address:
  • Phone: 706-597-1890
  • Fax: 706-595-5995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE W RUSSELL
Title or Position: OWNER
Credential: RN
Phone: 706-597-1890