Organization
COUNTRYSIDE NURSING LLC
Active
Other names
Countryside Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY TOLSON (MANAGER)
(404) 644-0471
Entity
Organization
Contact information
Practice address
233 CARROLLTON ST, BUCHANAN, GA 30113-4917
(770) 646-3861
(770) 646-3601
Mailing address
233 CARROLLTON ST, BUCHANAN, GA 30113-4917
(770) 646-3861
(770) 646-3601
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-071-2017
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000141666A
—
GA
Enumeration date
06/06/2013
Last updated
09/27/2013
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