Organization
SOUTHERN HEALTH CORP OF ELLIJAY
Active
Other names
GILMER NURSING HOME
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY M DUNN CEO (CHIEF EXECUTIVE OFFICER)
(706) 276-4741
Entity
Organization
Contact information
Practice address
1362 S MAIN ST, ELLIJAY, GA 30540-5410
(706) 276-4741
(706) 276-4745
Mailing address
PO BOX 1161, ELLIJAY, GA 30540-0015
(706) 276-4741
(706) 276-4745
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
1-061-1232
GA
314000000X
Skilled Nursing Facility
Primary
1-061-1232
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141127A
—
GA
01
—
501001
BLUE CROSS
GA
Enumeration date
01/02/2007
Last updated
01/17/2008
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