MEDICARE: PUTNAM COUNTY HEALTH CARE 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	1-117-1769	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1992799860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUTNAM COUNTY HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	125 SPARTA HIGHWAY
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024
Country	:	US
Telephone Number	:	706-485-8573
Fax Number	:	706-485-8283

Provider Business Practice Location Address
First Line	:	125 SPARTA HWY
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024-6093
Country	:	US
Telephone Number	:	706-485-8573
Fax Number	:	706-485-8283

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHALONDA WELLS
Credential	:
Telephone Number	:	706-485-8573

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	02/12/2026

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Directions to “PUTNAM COUNTY HEALTH CARE LLC ” Practice Location

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