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PROVIDENT VILLAGE AT CREEKSIDE
NPI 1891287645
Assisted Living Facility in Smyrna, GA

Active since June 06, 2018CLIA 11D2122676 · Waiver
4838 SOUTH COBB DRIVE, SMYRNA, GA 30080(678) 710-1834(678) 236-0374 Get Directions Write a Review

NPPES record last updated: June 6, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Provident Village At Creekside NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENT VILLAGE AT CREEKSIDE (NPI 1891287645) is a healthcare organization registered as an assisted living facility in Smyrna, Georgia and active in the NPI registry since June 2018. The organization holds a CLIA Waiver certificate valid through December 4, 2026 and lists Debra W. Lockwood, President & Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1891287645
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NamePROVIDENT GROUP - CREEKSIDE PROPERTIES LLC
Location Address4838 SOUTH COBB DRIVESmyrna, GA 30080
Mailing Address5565 Bankers AvenueBaton Rouge, LA 70808 · (225) 766-3977 · Fax (225) 766-3988
Phone(678) 710-1834
Fax(678) 236-0374
Organization SubpartNo
Authorized OfficialDebra W. LockwoodPresident & Chief Financial Officer · (225) 766-3977
Enumeration DateJune 6, 2018
✔ NPI 1891287645 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Also ListedAlzheimer Center (Dementia Center)Taxonomy 311500000X
Also ListedRespite CareTaxonomy 385H00000X
4838 SOUTH COBB DRIVE, Smyrna, GA 30080
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Other Names 1

Doing Business AsProvident Village At Creekside

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2122676

Provident Village Of Creekside · Smyrna, GA
Active · expires Dec 4, 2026
CLIA Number11D2122676
Laboratory TypeAssisted Living Facility
Certificate Effective DateDecember 5, 2024
Certificate Expiration DateDecember 4, 2026
Laboratory DirectorElaine Austin
Laboratory Phone(678) 903-0339
Laboratory LocationProvident Village Of Creekside4838 South Cobb Drive, Smyrna, GA 30080
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Provident Group - Creekside Properties LLC's NPI number?

The NPI number for Provident Group - Creekside Properties LLC is 1891287645. It was assigned to this organization in the NPPES registry on June 6, 2018. The provider is doing business as Provident Village At Creekside.

Where is Provident Group - Creekside Properties LLC located?

Provident Group - Creekside Properties LLC is located at 4838 South Cobb Drive, Smyrna, GA 30080. The listed phone number is (678) 710-1834.

What is Provident Group - Creekside Properties LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Provident Group - Creekside Properties LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2122676) is associated with this NPI, valid through December 4, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Provident Group - Creekside Properties LLC was last updated on June 6, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.