Healthcare Provider Details

I. General information

NPI: 1669572335
Provider Name (Legal Business Name): NEPTUNE CLINICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 CHICKAMAUGA AVE
ROSSVILLE GA
30741-1407
US

IV. Provider business mailing address

822 CHICKAMAUGA AVE
ROSSVILLE GA
30741-1407
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-6458
  • Fax: 706-866-6277
Mailing address:
  • Phone: 706-861-6458
  • Fax: 706-866-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS STEPHEN DAVIS
Title or Position: ADMINISTRATOR
Credential: CCS, CADC2, CAS
Phone: 706-861-6458