Healthcare Provider Details

I. General information

NPI: 1508426354
Provider Name (Legal Business Name): PHG WRIGHTSVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 W COURT ST
WRIGHTSVILLE GA
31096-5221
US

IV. Provider business mailing address

1350 SCENIC HWY N STE 266
SNELLVILLE GA
30078-7923
US

V. Phone/Fax

Practice location:
  • Phone: 229-868-0420
  • Fax:
Mailing address:
  • Phone: 678-808-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KAREN D FORRISTER
Title or Position: CEO
Credential:
Phone: 770-362-7316