MEDICARE: TALBOTT RECOVERY CAMPUS

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	106-094-D	GA

General Provider Information

NPI Number	:	1477835296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALBOTT RECOVERY CAMPUS

Provider Business Mailing Address
First Line	:	2153 PEACHFORD RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-6535
Country	:	US
Telephone Number	:	770-994-0185
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 BROOKSTONE CTR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904
Country	:	US
Telephone Number	:	770-994-0185
Fax Number	:

Authorized Official
Title or Position	:	SR VP CFO
Name	:	STEVE FILTON
Credential	:
Telephone Number	:	610-768-3300

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	10/04/2011

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