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General NPI Number Information
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NPI Number | 1740994342
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Entity Type | Organization
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Legal Business Name | -
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 318 W WALCOTT ST
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City | THOMASVILLE
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State | GA
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Zip | 31792
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Country | US
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Telephone | 229-201-0979
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Fax | 888-665-6733
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Provider Business Mailing Address
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Address Line | 318 W WALCOTT ST
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City | THOMASVILLE
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State | GA
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Zip | 31792
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Country | US
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Telephone | 229-201-0979
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Fax | 888-665-6733
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Authorized Official
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Title or Position | ADM
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Name | LOVETTA JONES
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Credential |
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Telephone | 229-200-9781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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