NPIMap

Organization Active NPI

Skilled Nursing Facility Grha

  • Skilled Nursing Facility
  • Decatur, GA
National Provider Identifier
1659409951
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1-044-323 Issued in GA
Legal business name
SKILLED NURSING FACILITY GRHA
Practice address
3073 Panthersville Road
Decatur, GA 30034-3828
Phone
(770) 212-5454
Fax
(404) 243-2159
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
John Mark Rowles, MD
Title
Clincial Director
Phone
(404) 243-2114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1-044-323 GA Primary

Addresses

Primary practice location

3073 Panthersville Road
Decatur, GA 30034-3828

Mailing address

P.O. Box 370407
Patient Accounts
Decatur, GA 30034-3828
Phone (404) 212-5454

Other identifiers 1

IdentifierTypeStateIssuer
00141061AMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Roosevelt Warm SGP Inst74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3073 Panthersville Rd
Decatur, GA 30034
Phone (404) 243-2100

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659409951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 370407",
            "address_2": "PATIENT ACCOUNTS",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300343828",
            "telephone_number": "404-212-5454",
            "fax_number": "404-243-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3073 PANTHERSVILLE ROAD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300343828",
            "telephone_number": "770-212-5454",
            "fax_number": "404-243-2159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKILLED NURSING FACILITY GRHA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROWLES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "CLINCIAL DIRECTOR",
        "authorized_official_telephone_number": "404-243-2114",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-044-323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00141061A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.