=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922908771
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRIOT VETERAN ADULT DAY HEALTH & WELLNESS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2026
-----------------------------------------------------
Last Update Date | 11/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2239 FLAT SHOALS RD SE UNIT 1224
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30316-3814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-353-7022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2239 FLAT SHOALS RD SE UNIT 1224
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30316-3814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-353-7022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | COREY LAMONT MARSHALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-353-7022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------