Healthcare Provider Details

I. General information

NPI: 1588665715
Provider Name (Legal Business Name): WINDER NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 E MAY ST
WINDER GA
30680-7132
US

IV. Provider business mailing address

PO BOX 588 263 EAST MAY ST.
WINDER GA
30680-0588
US

V. Phone/Fax

Practice location:
  • Phone: 770-867-2108
  • Fax:
Mailing address:
  • Phone: 770-867-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-007-1100
License Number StateGA

VIII. Authorized Official

Name: MR. GARY MICHAEL WESTBURY
Title or Position: ADMINISTRATOR
Credential:
Phone: 770-867-2108