Healthcare Provider Details

I. General information

NPI: 1922686682
Provider Name (Legal Business Name): CENTERED FOR LIFE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2487 DEMERE RD STE 500
ST SIMONS ISLAND GA
31522-5644
US

IV. Provider business mailing address

2487 DEMERE RD STE 500
ST SIMONS ISLAND GA
31522-5644
US

V. Phone/Fax

Practice location:
  • Phone: 912-268-4488
  • Fax:
Mailing address:
  • Phone: 912-268-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH ANN TEMMER
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 912-268-4488