Organization
LIAGIBA, INC
Active
Other names
Abigail Manor Personal Care Home
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EVAN WILLIAMS PHD (CEO/OWNER)
(770) 365-6820
Entity
Organization
Contact information
Practice address
518 LAKE MICHELE CT, STONE MOUNTAIN, GA 30088-1401
(770) 365-6820
(678) 528-3017
Mailing address
518 LAKE MICHELE CT, STONE MOUNTAIN, GA 30088-1401
(678) 528-3017
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
845251295B
—
GA
Enumeration date
02/13/2020
Last updated
02/13/2020
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