Provider Demographics
NPI:1225025828
Name:GEORGIA SUBACUTE SERVICES
Entity Type:Organization
Organization Name:GEORGIA SUBACUTE SERVICES
Other - Org Name:SOUTHERN TRADITIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-646-5512
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:GA
Mailing Address - Zip Code:30113-0310
Mailing Address - Country:US
Mailing Address - Phone:770-646-5512
Mailing Address - Fax:
Practice Address - Street 1:144 DEPOT ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:GA
Practice Address - Zip Code:30113-5216
Practice Address - Country:US
Practice Address - Phone:770-646-5512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115587Medicare ID - Type Unspecified