MEDICARE: ACS OF GEORGIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1457635815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACS OF GEORGIA

Provider Business Mailing Address
First Line	:	PO BOX 70241
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31708-0241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 W TIFT AVE
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-5800
Country	:	US
Telephone Number	:	229-809-0403
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	DERRICK SIMON
Credential	:
Telephone Number	:	229-809-0403

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	10/04/2011

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Directions to “ACS OF GEORGIA ” Practice Location

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