Southern Crescent Personal Care Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

031030131 Issued in GA

Legal business name

SOUTHERN CRESCENT PERSONAL CARE HOME

Practice address

630 Meriwether St
Griffin, GA 30224-4139

Phone

(770) 233-8116

Fax

(770) 233-8482

NPI assigned

Dec 29, 2006

Last updated

Jul 22, 2008By 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

Stephanie Odom

Title

Ceo

Phone

(770) 227-9222

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1639235047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 HIGHWAY 138 SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744007",
            "telephone_number": "678-610-4429",
            "fax_number": "678-610-4478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 MERIWETHER ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244139",
            "telephone_number": "770-233-8116",
            "fax_number": "770-233-8482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT PERSONAL CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-227-9222"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "031030131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040319876A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Valdon Smith
• Solutions to Thrive, LLC
• South Atlanta Lung and Sleep Clinic Inc.
• South Atlanta Radiology Associates- Griffin
• Southern Crescent Medical Services
• Southern Oral Surgery PC
• Southern Regional Medical Center Inc (Home Health)
• Southside Medical Center, Inc (Southside Medical Center - Spalding County)
• Spalding Ambulance
• Spalding Anesthesia Associates PC

• Assisted Living Facility in Griffin, GA
• Providers in Griffin, 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 Jul 22, 2008; 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.