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General NPI Number Information
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NPI Number | 1902963580
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Entity Type | Organization
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Legal Business Name | SOUTHERN HEALTH CORP OF ELLIJAY
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 1362 S MAIN ST
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City | ELLIJAY
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State | GA
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Zip | 30540-5410
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Country | US
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Telephone | 706-276-4741
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Fax | 706-276-4745
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Provider Business Mailing Address
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Address Line | PO BOX 1161
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City | ELLIJAY
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State | GA
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Zip | 30540-0015
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Country | US
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Telephone | 706-276-4741
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Fax | 706-276-4745
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JEFFREY M DUNN
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Credential | CEO
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Telephone | 706-276-4741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 1-061-1232
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1-061-1232
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License Number State | GA
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