Organization
LIZZY'S ADULT COMMUNITY SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MELVIN PARKER III (ADMINISTRATOR)
(706) 533-0218
Entity
Organization
Contact information
Practice address
1514 BALDWIN LAKES DR, GROVETOWN, GA 30813-5887
(706) 533-0218
(706) 869-2015
Mailing address
1514 BALDWIN LAKES DR, GROVETOWN, GA 30813-5887
(706) 533-0218
(706) 869-2015
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
366878280A
—
GA
05
—
366878280B
—
GA
Enumeration date
01/25/2013
Last updated
01/25/2013
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