Organization
MIONA GERIATRIC AND DEMENTIA CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM JULE WINDHAM (PRESIDENT)
(478) 967-2223
Entity
Organization
Contact information
Practice address
201 POPLAR ST, IDEAL, GA 31041-6264
(478) 949-2270
Mailing address
777 NURSING HOME RD, MARSHALLVILLE, GA 31057-3715
(478) 967-2223
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
08/19/2008
Last updated
10/27/2008
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