Organization
TRADITIONS HEALTH AND REHABILITATION CENTER LLC
Active
Other names
Traditions Health and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
SOUKHY CLARK (ADMINISTRATOR)
(770) 482-2961
Entity
Organization
Contact information
Practice address
2816 EVANS MILL RD, LITHONIA, GA 30058-7440
(770) 482-2961
(770) 484-8357
Mailing address
PO BOX 855, LITHONIA, GA 30058-0855
(770) 482-2961
(770) 484-8357
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-044-1789
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000143701A
—
GA
01
—
510012120 001
BCBS
—
Enumeration date
06/21/2006
Last updated
09/28/2023
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