MEDICARE: SUMMERHILL, LLC

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	314000000X	Skilled Nursing Facility	1-076-1106	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083603609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMERHILL, LLC

Provider Business Mailing Address
First Line	:	1211 MACON RD
Second Line	:	STE D
City	:	PERRY
State	:	GA
Zip	:	31069-2679
Country	:	US
Telephone Number	:	478-988-1294
Fax Number	:	478-988-1193

Provider Business Practice Location Address
First Line	:	500 STANLEY ST
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-3145
Country	:	US
Telephone Number	:	478-987-3100
Fax Number	:	478-987-0664

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM C. DAVIS JR.
Credential	:
Telephone Number	:	478-988-1294

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	04/13/2012

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Directions to “SUMMERHILL, LLC ” Practice Location

Language	Start Address	Practice Location

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