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NPI Code Detail

MEDICARE: CARROLLTON MANOR INC

MEDICARE: CARROLLTON MANOR INC
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
1314000000XSkilled Nursing Facility1-022-1170GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922003177
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARROLLTON MANOR INC
Provider Business Mailing Address
First Line : PO BOX 2398
Second Line :
City : CARROLLTON
State : GA
Zip : 30112-0044
Country : US
Telephone Number : 770-834-1737
Fax Number : 770-836-1223
Provider Business Practice Location Address
First Line : 2455 OAK GROVE CHURCH RD
Second Line :
City : CARROLLTON
State : GA
Zip : 30117-9513
Country : US
Telephone Number : 770-834-1737
Fax Number : 770-836-1223
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. EVELYN THOMPSON
Credential :
Telephone Number : 770-834-1737
Provider Enumeration Date : 06/15/2005
Last Update Date : 08/22/2020

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Directions to “CARROLLTON MANOR INC ” Practice Location

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