Healthcare Provider Details

I. General information

NPI: 1336656578
Provider Name (Legal Business Name): GEORBEA ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15938 US HIGHWAY 17
TOWNSEND GA
31331-3706
US

IV. Provider business mailing address

1038 BREEZE WAY AVE NE
TOWNSEND GA
31331-6511
US

V. Phone/Fax

Practice location:
  • Phone: 912-342-2788
  • Fax: 877-408-8199
Mailing address:
  • Phone: 912-342-2788
  • Fax: 877-408-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008947
License Number StateGA

VIII. Authorized Official

Name: DR. AUNDRA SIMMONS VAUGHN
Title or Position: OWNER/PROVIDER
Credential: LPC
Phone: 912-342-2788