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General NPI Number Information
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NPI Number | 1417408519
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Entity Type | Organization
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Legal Business Name | GEORGIA LIFE LINKS
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 1544 VENETIAN DR SW
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City | ATLANTA
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State | GA
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Zip | 30311-3550
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Country | US
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Telephone | 404-755-3197
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Fax |
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Provider Business Mailing Address
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Address Line | 1544 VENETIAN DR SW
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City | ATLANTA
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State | GA
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Zip | 30311-3550
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Country | US
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Telephone | 404-755-3197
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARION ELAINE REESE-THOMPSON
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Credential |
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Telephone | 404-755-3197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 014100LGB
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License Number State | GA
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