Organization
SKILLED NURSING FACILITY GRHA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MARK ROWLES MD (CLINCIAL DIRECTOR)
(404) 243-2114
Entity
Organization
Contact information
Practice address
3073 PANTHERSVILLE ROAD, DECATUR, GA 30034-3828
(770) 212-5454
(404) 243-2159
Mailing address
P.O. BOX 370407, PATIENT ACCOUNTS, DECATUR, GA 30034-3828
(404) 212-5454
(404) 243-2159
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-044-323
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141061A
—
GA
Enumeration date
03/01/2007
Last updated
08/22/2020
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