Healthcare Provider Details

I. General information

NPI: 1801979588
Provider Name (Legal Business Name): DOBSON ROAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 DOBSON RD
SAVANNAH GA
31410-2327
US

IV. Provider business mailing address

204 DOBSON RD
SAVANNAH GA
31410-2327
US

V. Phone/Fax

Practice location:
  • Phone: 912-898-3276
  • Fax: 912-898-3277
Mailing address:
  • Phone: 912-898-3276
  • Fax: 912-898-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateGA

VIII. Authorized Official

Name: CHARLES LI
Title or Position: RHA
Credential:
Phone: 912-356-2011