MEDICARE: LANIER TREATMENT CENTER

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1215492186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANIER TREATMENT CENTER

Provider Business Mailing Address
First Line	:	592 MEDICAL PARK DR STE A
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2055
Country	:	US
Telephone Number	:	770-503-7721
Fax Number	:

Provider Business Practice Location Address
First Line	:	592 MEDICAL PARK DR STE A
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2055
Country	:	US
Telephone Number	:	770-503-7721
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	BRADWELL RUSTIN MCALISTER II
Credential	:	MD
Telephone Number	:	770-503-7721

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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