Healthcare Provider Details

I. General information

NPI: 1750871794
Provider Name (Legal Business Name): EVERETT E. TOLBERT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 FREDERICK ST
SAVANNAH GA
31405-4812
US

IV. Provider business mailing address

33 BRANDLE WAY
SAVANNAH GA
31405-2764
US

V. Phone/Fax

Practice location:
  • Phone: 912-220-7564
  • Fax: 912-335-5655
Mailing address:
  • Phone: 912-220-7564
  • Fax: 912-335-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number008212
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. EVERETT E TOLBERT
Title or Position: OWNER/ THERAPIST
Credential: LPC
Phone: 912-220-7564