MEDICARE: COTTON CARE GROUP HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1023944998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTON CARE GROUP HOME

Provider Business Mailing Address
First Line	:	12461 VETERANS MEMORIAL HWY
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-2025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12461 VETERANS MEMORIAL HWY
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-2025
Country	:	US
Telephone Number	:	256-214-0080
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RODNEY GORDON
Credential	:	OWNER
Telephone Number	:	256-214-0080

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/19/2026

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