Provider Demographics
NPI:1003845967
Name:THE NATHANIEL WATSON, JR. MEMORIAL FOUNDATION, INC
Entity Type:Organization
Organization Name:THE NATHANIEL WATSON, JR. MEMORIAL FOUNDATION, INC
Other - Org Name:BALM OF GILEAD MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON-BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-693-8852
Mailing Address - Street 1:506 CALGARY GLEN DRIVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-7284
Mailing Address - Country:US
Mailing Address - Phone:770-732-9196
Mailing Address - Fax:770-770-0739
Practice Address - Street 1:506 CALGARY GLEN DRIVE SW
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-7284
Practice Address - Country:US
Practice Address - Phone:770-770-9196
Practice Address - Fax:770-732-0739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE NATHANIEL WATSON, JR. MEMORIAL FOUNDATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
GA3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric