Healthcare Provider Details

I. General information

NPI: 1104970193
Provider Name (Legal Business Name): THE RENAISSANCE CENTRE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N JACKSON ST
ALBANY GA
31701
US

IV. Provider business mailing address

506 N JACKSON ST.
ALBANY GA
31701
US

V. Phone/Fax

Practice location:
  • Phone: 229-889-7200
  • Fax: 229-889-7393
Mailing address:
  • Phone: 229-889-7200
  • Fax: 229-889-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MARGARET BECK
Title or Position: OFFICE MANAGER
Credential:
Phone: 229-889-7200