MEDICARE: THE FOX CLUB 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1427906932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FOX CLUB LLC

Provider Business Mailing Address
First Line	:	106 E PACES DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-5217
Country	:	US
Telephone Number	:	706-247-2741
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 E PACES DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-5217
Country	:	US
Telephone Number	:	706-247-2741
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SHUJUAN TAO MCDONALD
Credential	:
Telephone Number	:	706-247-2741

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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Directions to “THE FOX CLUB LLC ” Practice Location

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