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General NPI Number Information
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NPI Number | 1295120145
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Entity Type | Organization
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Legal Business Name | CCSG, INC.
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 116 MIMOSA DR
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City | THOMASVILLE
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State | GA
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Zip | 31792-6605
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Country | US
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Telephone | 229-551-0083
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Fax |
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Provider Business Mailing Address
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Address Line | 116 MIMOSA DR
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City | THOMASVILLE
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State | GA
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Zip | 31792-6605
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Country | US
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Telephone | 229-551-0083
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. GREGORY HEMBREE
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Credential |
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Telephone | 229-228-2853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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