Provider Demographics
NPI:1093008542
Name:DOGWOOD PLANTATION OF FULTON
Entity type:Organization
Organization Name:DOGWOOD PLANTATION OF FULTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:F. G.
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-624-2425
Mailing Address - Street 1:201 WEST PIERCETOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843
Mailing Address - Country:US
Mailing Address - Phone:662-840-3111
Mailing Address - Fax:662-840-3119
Practice Address - Street 1:201 W PIERCETOWN RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-8597
Practice Address - Country:US
Practice Address - Phone:662-862-6120
Practice Address - Fax:662-862-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS933310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility