Healthcare Provider Details

I. General information

NPI: 1467793455
Provider Name (Legal Business Name): SUPPORT SOLUTIONS OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 PITCARIN WAY
AUGUSTA GA
30909-5767
US

IV. Provider business mailing address

207 PITCARIN WAY
AUGUSTA GA
30909-5767
US

V. Phone/Fax

Practice location:
  • Phone: 706-396-0584
  • Fax: 706-396-0544
Mailing address:
  • Phone: 706-396-0584
  • Fax: 706-396-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberCLA000914
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number121-R-1009
License Number StateGA

VIII. Authorized Official

Name: DR. LARRY DURBIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: ED
Phone: 901-383-9193