| Willowbrooke At Tanner | |
|
601 Dallas Hwy Villa Rica GA 30180-1202 | |
| (770) 456-3000 | |
| (770) 456-3390 |
| Full Name | Willowbrooke At Tanner |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 601 Dallas Hwy, Villa Rica, Georgia |
| Authorized Official Name and Position | Lee C. Sherseth (CFO) |
| Authorized Official Contact | 7708369697 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willowbrooke At Tanner Po Box 638 Villa Rica GA 30180-0638 Ph: (770) 836-9666 | Willowbrooke At Tanner 601 Dallas Hwy Villa Rica GA 30180-1202 Ph: (770) 456-3000 |
| NPI Number | 1104066265 |
|---|---|
| Provider Enumeration Date | 03/03/2009 |
| Last Update Date | 07/28/2010 |
| Medicare PECOS PAC ID | 2961307533 |
|---|---|
| Medicare Enrollment ID | O20090803000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104066265 | NPI | - | NPPES |
| 000002032A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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