Healthcare Provider Details

I. General information

NPI: 1801969175
Provider Name (Legal Business Name): GEORGIA CORRECTIONAL INDUSTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 UNDERWOOD DR
TRION GA
30753-1500
US

IV. Provider business mailing address

2984 CLIFTON SPRINGS RD
DECATUR GA
30034-3820
US

V. Phone/Fax

Practice location:
  • Phone: 706-857-0650
  • Fax: 706-857-0652
Mailing address:
  • Phone: 404-244-5100
  • Fax: 404-244-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY WATSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 404-244-5100