Wickshire Canton Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WICKSHIRE CANTON OPCO LLC

Practice address

125 Riverstone Terrace
Canton, GA 30114

Phone

(770) 720-9669

Fax

(678) 880-3689

NPI assigned

Jan 2, 2020

Last updated

Jan 2, 2020By 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

Mr. Daniel Okeefe, JD

Title

Ceo

Phone

(615) 942-0240

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1619516093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 OLD HICKORY BLVD",
            "address_2": "BUILDING ONE SUITE 125",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "37027",
            "telephone_number": "615-942-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 RIVERSTONE TERRACE",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30114",
            "telephone_number": "770-720-9669",
            "fax_number": "678-880-3689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKSHIRE CANTON OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-02",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "OKEEFE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-942-0240",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Katherine Thrash White, NP
• Mikayla Beverly White
• Rachel Strickland White, RD
• Natalie Paris Whitehead, APC
• Ernest Lee Whitmarsh Jr., PH.D.
• Douglas B Widener, M.D.
• Jongbin Wie, DMD
• Gina Marie Wiedrich, MT
• Benjamin Russell Wiener, MD
• Memorie S Wilcoxon, PHARMD

• Assisted Living Facility in Canton, GA
• Providers in Canton, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.