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General NPI Number Information
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NPI Number | 1104255256
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Entity Type | Organization
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Legal Business Name | COMMUNITY SERVICE BOARD OF MIDDLE GEORGIA
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 2121A BELLEVUE RD
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City | DUBLIN
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State | GA
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Zip | 31021-2998
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Country | US
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Telephone | 478-272-1190
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Fax | 478-275-6649
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Provider Business Mailing Address
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Address Line | 2121A BELLEVUE RD
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City | DUBLIN
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State | GA
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Zip | 31021-2998
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Country | US
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Telephone | 478-272-1190
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Fax | 478-275-6649
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Authorized Official
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Title or Position | OPERATIONS ANALYST
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Name | CYNTHIA REID
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Credential |
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Telephone | 478-272-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 084851
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License Number State | GA
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