Organization
ICFMR AT GEORGIA REGIONAL HOSPITAL ATLANTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SONNY SLATE COO (CHIEF OPERATION OFFICER)
(404) 243-2121
Entity
Organization
Contact information
Practice address
3073 PANTHERSVILLE ROAD, DECATUR, GA 30034-3828
(404) 243-2158
(404) 243-2159
Mailing address
P.O. BOX 370407, DECATUR, GA 30034-3828
(404) 243-2158
(404) 243-2159
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2044856
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141061A
—
GA
Enumeration date
03/01/2007
Last updated
08/18/2009
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