Healthcare Provider Details

I. General information

NPI: 1922708254
Provider Name (Legal Business Name): TBFF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SESSIONS DR
MACON GA
31201-2317
US

IV. Provider business mailing address

150 SESSIONS DR
MACON GA
31201-2317
US

V. Phone/Fax

Practice location:
  • Phone: 404-625-5907
  • Fax:
Mailing address:
  • Phone: 404-625-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCUS E WINDHOM SR.
Title or Position: CEO
Credential:
Phone: 404-625-5907