Healthcare Provider Details

I. General information

NPI: 1780797415
Provider Name (Legal Business Name): GEORGIA DEPT OF HUMAN RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 OGLETHORPE AVE SW
MILLEDGEVILLE GA
31061-4639
US

IV. Provider business mailing address

647 SWINT AVE
MILLEDGEVILLE GA
31062-7525
US

V. Phone/Fax

Practice location:
  • Phone: 478-445-8182
  • Fax:
Mailing address:
  • Phone: 478-445-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE HARRIS
Title or Position: DIRECTOR
Credential:
Phone: 478-445-8182