Healthcare Provider Details

I. General information

NPI: 1851538573
Provider Name (Legal Business Name): TRINITY TREATMENT CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 NEWBERG AVE
MACON GA
31206-3011
US

IV. Provider business mailing address

PO BOX 3613
MACON GA
31205-3613
US

V. Phone/Fax

Practice location:
  • Phone: 478-788-5600
  • Fax: 478-788-5660
Mailing address:
  • Phone: 478-788-5600
  • Fax: 478-788-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberNTP001036
License Number StateGA

VIII. Authorized Official

Name: MRS. KARINE ALLEYNE
Title or Position: PROGRAM ADMINISTRATOR
Credential: R.PH
Phone: 478-788-5600