Healthcare Provider Details

I. General information

NPI: 1578125282
Provider Name (Legal Business Name): GEORGIA TREATMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6132 HAWKINSVILL ROAD
MACON GA
31216
US

IV. Provider business mailing address

7134 S YALE AVE STE 560
TULSA OK
74136-6352
US

V. Phone/Fax

Practice location:
  • Phone: 478-788-0066
  • Fax: 478-785-3104
Mailing address:
  • Phone: 478-788-0066
  • Fax: 478-785-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SCOTT THOMPSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 918-289-0270