MEDICARE: 460 AUBURN AVENUE, L.P.

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		GA

General Provider Information

NPI Number	:	1174909840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	460 AUBURN AVENUE, L.P.

Provider Business Mailing Address
First Line	:	3000 OLD ALABAMA RD STE 119-403
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-5860
Country	:	US
Telephone Number	:	404-282-4755
Fax Number	:	404-681-4536

Provider Business Practice Location Address
First Line	:	460 AUBURN AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1504
Country	:	US
Telephone Number	:	404-523-1613
Fax Number	:	404-681-4536

Authorized Official
Title or Position	:	CFO
Name	:	DAREN DOUSTON
Credential	:
Telephone Number	:	404-282-4755

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	12/21/2023

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