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General NPI Number Information
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NPI Number | 1437489762
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA PERSONAL CARE LLC
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 80 LARKSPUR LN 80 LARKSPUR LANE
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City | TALKING ROCK
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State | GA
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Zip | 30175-3743
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Country | US
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Telephone | 706-253-0131
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Fax | 706-253-0131
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Provider Business Mailing Address
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Address Line | 80 LARKSUPR LANE
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City | TALKING ROCK
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State | GA
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Zip | 30175
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Country | US
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Telephone | 706-253-0131
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Fax | 706-253-0131
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Authorized Official
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Title or Position | OWNER
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Name | MS. ROSE MARY DAVIDSON
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Credential | (706)0253-0131
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Telephone | 706-253-0131
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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 | 112-R-0521
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License Number State | GA
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