Healthcare Provider Details

I. General information

NPI: 1043227929
Provider Name (Legal Business Name): MIDDLE FLINT AREA COMMUNITY SERVICE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N JACKSON ST
AMERICUS GA
31709-3015
US

IV. Provider business mailing address

PO BOX 1348
AMERICUS GA
31709-1348
US

V. Phone/Fax

Practice location:
  • Phone: 229-931-2470
  • Fax: 229-931-2474
Mailing address:
  • Phone: 229-931-2470
  • Fax: 229-931-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE008689
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANGELA HOLT
Title or Position: CEO
Credential:
Phone: 229-815-5454