Healthcare Provider Details

I. General information

NPI: 1205209608
Provider Name (Legal Business Name): GOOD SAMARITAN CLINIC OF WASHINGTON COUNTY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 E ALEXANDER ST
GREENVILLE MS
38703-3330
US

IV. Provider business mailing address

PO BOX 231
POWDER SPRINGS GA
30127-0231
US

V. Phone/Fax

Practice location:
  • Phone: 662-347-3034
  • Fax:
Mailing address:
  • Phone: 770-672-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA ANDERSON
Title or Position: CEO
Credential:
Phone: 662-347-3034