Healthcare Provider Details

I. General information

NPI: 1427224153
Provider Name (Legal Business Name): WILKINSON PERSONAL CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 HOSPITAL DR
TOCCOA GA
30577-7846
US

IV. Provider business mailing address

269 HOSPITAL DR
TOCCOA GA
30577-7846
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-2977
  • Fax:
Mailing address:
  • Phone: 706-282-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number127030011
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL S HESTER
Title or Position: CEO
Credential:
Phone: 706-282-4200