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NPI Code Detail

MEDICARE: ETHEN ROYAL

MEDICARE: ETHEN ROYAL
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
1310400000XAssisted Living FacilityGA

General Provider Information

NPI Number : 1740127018
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHEN ROYAL
Provider Business Mailing Address
First Line : 206 ORCHARD WAY
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-4434
Country : US
Telephone Number : 478-257-1367
Fax Number : 478-257-1367
Provider Business Practice Location Address
First Line : 311 E IMPERIAL CIR
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31093-2201
Country : US
Telephone Number : 478-257-1367
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/04/2026

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Directions to “ ETHEN ROYAL ” Practice Location

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