Healthcare Provider Details

I. General information

NPI: 1861505430
Provider Name (Legal Business Name): DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 LAWRENCE RD CENTRAL STATE HOSPITAL
MILLEDGEVILLE GA
31062-7525
US

IV. Provider business mailing address

325 LAWRENCE RD CENTRAL STATE HOSPITAL
MILLEDGEVILLE GA
31062-7525
US

V. Phone/Fax

Practice location:
  • Phone: 478-445-4041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPHH006409
License Number StateGA

VIII. Authorized Official

Name: DR. LARRY LATHAM
Title or Position: REGIONAL HOSPITAL ADMINISTRATOR
Credential:
Phone: 478-445-4128