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Organization

TRACES OF TIGER I

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. CARLIE S PENNINGTON (SOLE MB)
(706) 746-6571
Entity
Organization

Contact information

Practice address
382 BRIDGE CREEK RD, TIGER, GA 30576-2211
(706) 782-6208
(706) 782-5019
Mailing address
382 BRIDGE CREEK RD, TIGER, GA 30576-2211
(706) 782-6208
(706) 782-5019

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
119030011
GA

Other

Enumeration date
08/03/2016
Last updated
08/03/2016
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