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General NPI Number Information
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NPI Number | 1457291445
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Entity Type | Organization
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Legal Business Name | GOLDEN POND RESIDENTIAL CENTER
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 8167 EISENHOWER PKWY
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City | LIZELLA
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State | GA
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Zip | 31052-3219
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Country | US
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Telephone | 478-747-7153
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Fax |
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Provider Business Mailing Address
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Address Line | 8167 EISENHOWER PKWY
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City | LIZELLA
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State | GA
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Zip | 31052-3219
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Country | US
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Telephone | 478-747-7153
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FLORA IVEY
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Credential |
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Telephone | 478-747-7153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number |
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License Number State |
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