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General NPI Number Information
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NPI Number | 1376268177
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Entity Type | Organization
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Legal Business Name | INTEGRITY LONG TERM CARE LLC
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 1600 RIVERSIDE AVE
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City | WAYCROSS
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State | GA
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Zip | 31501-7028
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Country | US
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Telephone | 912-490-4325
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Fax | 912-490-2873
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Provider Business Mailing Address
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Address Line | 808 BEACON ST
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City | WAYCROSS
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State | GA
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Zip | 31501-7104
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Country | US
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Telephone | 912-490-4325
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Fax | 912-490-2873
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | WILLIAM ALAN MORTON
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Credential | MD
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Telephone | 912-490-4325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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