Organization
CORRECTLIFE BOSTICK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLO A MUSSO MD (PRESIDENT)
(770) 692-4750
Entity
Organization
Contact information
Practice address
1 BOSTICK CIR, MILLEDGEVILLE, GA 31062-7526
(770) 692-4750
Mailing address
3384 PEACHTREE RD NE, SUITE 700, ATLANTA, GA 30326-1181
(770) 692-4750
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Enumeration date
03/22/2016
Last updated
04/06/2016
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