Healthcare Provider Details

I. General information

NPI: 1619511334
Provider Name (Legal Business Name): DOUGLASVILLE HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4158 WASHINGTON RD STE 4
EVANS GA
30809-4720
US

IV. Provider business mailing address

2935 N ASHLEY ST STE 114
VALDOSTA GA
31602-1788
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-9225
  • Fax: 706-854-9226
Mailing address:
  • Phone: 229-242-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: ALAN COOPER FOLSOM
Title or Position: MEMBER
Credential:
Phone: 229-242-0953