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General NPI Number Information
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NPI Number | 1851720569
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Entity Type | Organization
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Legal Business Name | NURSING CARE OF GEORGIA
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Dates
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Enumeration Date | 11/03/2013
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Last Update Date | 11/03/2013
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Provider Practice Location Address
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Address Line | 4500 HUGH HOWELL RD STE 360
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City | TUCKER
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State | GA
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Zip | 30084-4729
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Country | US
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Telephone | 470-299-3192
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 HUGH HOWELL RD STE 360
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City | TUCKER
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State | GA
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Zip | 30084-4729
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Country | US
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Telephone | 470-299-3192
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY LEWIS
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Credential | RN
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Telephone | 678-438-1492
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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 | 044-R-1209
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License Number State | GA
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