# PANOLA CARE, CLA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134564131
- **Authorized official:** MISS CAROL A TAVARES (DIRECTOR)
- **Authorized official phone:** (770) 322-6810

## Contact information

- **Practice address:** 3169 PEQUEA DR, LITHONIA, GA 30038-1119
- **Practice address phone:** (770) 322-6810
- **Practice address fax:** (770) 322-6810
- **Mailing address:** 3169 PEQUEA DR, LITHONIA, GA 30038-1119
- **Mailing address phone:** (770) 322-6810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | — |

## Other

- **Enumeration date:** 05/03/2013
- **Last updated:** 05/03/2013