Healthcare Provider Details

I. General information

NPI: 1245478288
Provider Name (Legal Business Name): LOOKOUT MOUNTAIN COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MILLSAP RD
LA FAYETTE GA
30728-6339
US

IV. Provider business mailing address

PO BOX 1027
LA FAYETTE GA
30728-1027
US

V. Phone/Fax

Practice location:
  • Phone: 706-638-5580
  • Fax: 706-638-5585
Mailing address:
  • Phone: 706-638-5580
  • Fax: 706-638-5585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICIA MICHELLE HOWARD
Title or Position: CREDENTIALING
Credential:
Phone: 706-670-1080