Healthcare Provider Details

I. General information

NPI: 1225181779
Provider Name (Legal Business Name): NEW HORIZONS CSB STEWART COUNTY C & A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 DEPOT ST
RICHLAND GA
31825-1015
US

IV. Provider business mailing address

2100 COMER AVE
COLUMBUS GA
31904-8725
US

V. Phone/Fax

Practice location:
  • Phone: 229-887-2180
  • Fax: 229-887-2183
Mailing address:
  • Phone: 706-596-5583
  • Fax: 706-596-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: PERRY ALEXANDER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 706-596-5582