MEDICARE: THOMASVILLE OPERATIONS 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

General Provider Information

NPI Number	:	1720719875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMASVILLE OPERATIONS LLC

Provider Business Mailing Address
First Line	:	120 SKYLINE DR
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31757-2507
Country	:	US
Telephone Number	:	229-225-1049
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 SKYLINE DR
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31757-2507
Country	:	US
Telephone Number	:	229-225-1049
Fax Number	:

Authorized Official
Title or Position	:	MEMBER OF LLC
Name	:	BRENT S MORRISON
Credential	:
Telephone Number	:	678-368-4402

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	06/20/2022

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Directions to “THOMASVILLE OPERATIONS LLC ” Practice Location

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