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Organization
ICFMR AT GEORGIA REGIONAL HOSPITAL ATLANTA
Active
Organization
ICFMR AT GEORGIA REGIONAL HOSPITAL ATLANTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SONNY SLATE COO (CHIEF OPERATION OFFICER)
(404) 243-2121
Entity
Organization
Contact information
Practice address
3073 PANTHERSVILLE ROAD, DECATUR, GA 30034-3828
(404) 243-2158
(404) 243-2159
Mailing address
P.O. BOX 370407, DECATUR, GA 30034-3828
(404) 243-2158
(404) 243-2159
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
—
NULL
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2044856
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141061A
—
GA
Enumeration date
03/01/2007
Last updated
08/18/2009
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