Willie B Gardner Assisted Living Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WILLIE B GARDNER ASSISTED LIVING INC.

Doing business as

Willie B Gardner Care Home Inc.

Practice address

1262 King Rd
Riverdale, GA 30296-2952

Phone

(678) 789-5174

NPI assigned

Feb 6, 2023

Organization subpart

No

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

Authorized official

Name

Shaurina S. Dudley

Title

Ceo

Phone

(678) 663-9674

Specialties & licenses 1

Addresses

Other names 1

• Willie B Gardner Care Home Inc. Doing business as

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

{
    "created_epoch": "1675641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1710683396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1262 KING RD",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302962952",
            "telephone_number": "678-789-5174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1262 KING RD",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302962952",
            "telephone_number": "678-789-5174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIE B GARDNER ASSISTED LIVING INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-06",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-04",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "SHAURINA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-663-9674"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willie B Gardner Care Home Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Genesis M Williams
• Jennifer Williams, CNM
• Minnette Williams, M.D.
• Monetriya Chenea Williams, FNP
• Judy T Williamson, CNM
• Willie M. Winzer MD PC
• Claire K Willie, MD
• Willow Oak Community Behavioral Health Center, Inc.
• Kami' Aquira Wilson
• Simone Wilson

• Assisted Living Facility in Riverdale, GA
• Providers in Riverdale, 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 Feb 6, 2023; 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.