Healthcare Provider Details

I. General information

NPI: 1316195977
Provider Name (Legal Business Name): COLUMBUS PSR/PEER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9067 VETERANS PARKWAY
COLUMBUS GA
31901
US

IV. Provider business mailing address

9067 VETERANS PARKWAY
COLUMBUS GA
31901
US

V. Phone/Fax

Practice location:
  • Phone: 706-641-9663
  • Fax: 706-494-7072
Mailing address:
  • Phone: 706-641-9663
  • Fax: 706-494-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: KENNETH WHIDDON
Title or Position: OWNER/CEO
Credential:
Phone: 912-638-0350