Healthcare Provider Details

I. General information

NPI: 1912175167
Provider Name (Legal Business Name): GEORGIA PINES COMMUNITY SERVICE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 PRIDE ST
PELHAM GA
31779-5370
US

IV. Provider business mailing address

1102 SMITH AVE
THOMASVILLE GA
31792-5739
US

V. Phone/Fax

Practice location:
  • Phone: 229-225-4335
  • Fax: 229-225-4374
Mailing address:
  • Phone: 229-225-4335
  • Fax: 229-225-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT H JONES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 229-225-4373