Countryside Nursing LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-071-2017 Issued in GA

Legal business name

COUNTRYSIDE NURSING LLC

Doing business as

Countryside Health Center

Practice address

233 Carrollton St
Buchanan, GA 30113-4917

Phone

(770) 646-3861

Fax

(770) 646-3601

NPI assigned

Jun 6, 2013

Last updated

Sep 27, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Terry Tolson

Title

Manager

Phone

(404) 644-0471

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Countryside Health Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380240000000",
    "number": "1114365657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 CARROLLTON ST",
            "city": "BUCHANAN",
            "state": "GA",
            "postal_code": "301134917",
            "telephone_number": "770-646-3861",
            "fax_number": "770-646-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 CARROLLTON ST",
            "city": "BUCHANAN",
            "state": "GA",
            "postal_code": "301134917",
            "telephone_number": "770-646-3861",
            "fax_number": "770-646-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE NURSING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-06",
        "last_updated": "2013-09-27",
        "status": "A",
        "authorized_official_last_name": "TOLSON",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "404-644-0471"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-071-2017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000141666A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Comfort Care Ministries, Inc (West Georgia Counseling and Educational Services)
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• Jeremiah Eugene Cook
• Patrick Manning Cook, PHARM.D.
• Cornerstone Autism Solutions LLC
• CS SNF LLC (Countryside Health Center)
• Denis Morin (Buchanan Medical Clinic)
• Denis Morin (buchanan medical clinic)
• Erin Wurtz Everson
• Kellilyn Gates

• Skilled Nursing Facility in Buchanan, GA
• Providers in Buchanan, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.