Moma 2022 W2

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256-37-5248 34128.57 256-37-5248 34128.

57

35768.04 2217.62 35768.04 2217.62


54-2101776 35768.04 518.64 54-2101776 35768.04 518.64
Coffee County Nursing Home, LLC Coffee County Nursing Home, LLC
1310 West Gordon Street 1310 West Gordon Street
Douglas, GA 31533 Douglas, GA 31533

Alisa Johnson Alisa Johnson


328 Pinecrest Drive 328 Pinecrest Drive
Douglas, GA 31535 Douglas, GA 31535

D 1639.47 D 1639.47

DD 12741.04 DD 12741.04

GA 2187746-UQ 34128.57 956.24 GA 2187746-UQ 34128.57 956.24

256-37-5248 34128.57 256-37-5248 34128.57

35768.04 2217.62 35768.04 2217.62


54-2101776 35768.04 518.64 54-2101776 35768.04 518.64
Coffee County Nursing Home, LLC Coffee County Nursing Home, LLC
1310 West Gordon Street 1310 West Gordon Street
Douglas, GA 31533 Douglas, GA 31533

Alisa Johnson Alisa Johnson


328 Pinecrest Drive 328 Pinecrest Drive
Douglas, GA 31535 Douglas, GA 31535

D 1639.47 D 1639.47

DD 12741.04 DD 12741.04

GA 2187746-UQ 34128.57 956.24 GA 2187746-UQ 34128.57 956.24

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