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General NPI Number Information
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NPI Number | 1467700732
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Entity Type | Organization
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Legal Business Name | PATHWAYS HOPES CORNER
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Dates
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Enumeration Date | 08/17/2012
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Last Update Date | 08/17/2012
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Provider Practice Location Address
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Address Line | 756 WOODBURY HWY
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City | GREENVILLE
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State | GA
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Zip | 30222-1514
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Country | US
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Telephone | 706-775-0544
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Fax |
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Provider Business Mailing Address
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Address Line | 756 WOODBURY HWY
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City | GREENVILLE
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State | GA
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Zip | 30222-1514
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Country | US
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Telephone | 706-775-0544
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Fax |
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Authorized Official
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Title or Position | STAFF NURSE
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Name | MISS JACQUELYN ALTHEA WHATLEY
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Credential | RN
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Telephone | 706-775-0544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | RN147778
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License Number State | GA
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