Healthcare Provider Details

I. General information

NPI: 1477680973
Provider Name (Legal Business Name): SOUTH GEORGIA PSYCHIATRIC & COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N OAK ST BUILDING B-3
VALDOSTA GA
31602-1744
US

IV. Provider business mailing address

2704 N OAK ST BUILDING B-3
VALDOSTA GA
31602-1744
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-0100
  • Fax: 229-257-0050
Mailing address:
  • Phone: 229-257-0100
  • Fax: 229-257-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL SHEFFIELD
Title or Position: OFFICE MANAGER
Credential:
Phone: 229-257-0100