Healthcare Provider Details

I. General information

NPI: 1205156932
Provider Name (Legal Business Name): PROJECT REBOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 FRANCIS ST
COLUMBUS GA
31906-2512
US

IV. Provider business mailing address

2833 MIMOSA ST
COLUMBUS GA
31906-2163
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-4830
  • Fax: 706-221-4830
Mailing address:
  • Phone: 706-221-4830
  • Fax: 706-221-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number062999
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCSW003530
License Number StateGA

VIII. Authorized Official

Name: DR. JIHAD HUD
Title or Position: FOUNDER / CEO
Credential:
Phone: 706-221-4830