Organization
SOVEREIGN HEALTHCARE OF BUCHANAN, LLC
Active
Other names
Southern Traditions
Organization subpart
No
Provider details
NPI number
Authorized official
MR. R. MARK CRONQUIST (MANAGER)
(404) 574-2100
Entity
Organization
Contact information
Practice address
144 DEPOT ST, BUCHANAN, GA 30113-5216
(770) 646-5512
(770) 646-5591
Mailing address
5887 GLENRIDGE DR NE, SUITE 150, ATLANTA, GA 30328-5574
(404) 574-2100
(404) 574-2105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
1-071-1896
GA
314000000X
Skilled Nursing Facility
Primary
1-071-1897
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000142722A
—
GA
Enumeration date
06/12/2007
Last updated
09/24/2014
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