Healthcare Provider Details

I. General information

NPI: 1609924752
Provider Name (Legal Business Name): SOUTH CENTRAL COMMUNITY SERVICES AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COLLEGE PARK DRIVE SUITE D
COLUMBIA TN
38401
US

IV. Provider business mailing address

PO BOX 459
COLUMBIA TN
38402-0459
US

V. Phone/Fax

Practice location:
  • Phone: 931-375-5000
  • Fax: 931-375-2011
Mailing address:
  • Phone: 931-375-5000
  • Fax: 931-375-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL LYNCH
Title or Position: DIRECTOR
Credential:
Phone: 931-375-5000