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General NPI Number Information
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NPI Number | 1316186968
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Entity Type | Organization
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Legal Business Name | MEDMARK TREATMENT CENTERS OF GEORGIA, INC.
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 20 COMMERCE DR
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-8913
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Country | US
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Telephone | 706-781-6987
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Fax | 706-781-3026
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Provider Business Mailing Address
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Address Line | 1720 LAKEPOINTE DR STE 117
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City | LEWISVILLE
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State | TX
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Zip | 75057-6425
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Country | US
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Telephone | 214-379-3300
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Fax | 214-853-9018
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Authorized Official
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Title or Position | VP, TREASURER
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Name | BRUCE JARVIE
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Credential |
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Telephone | 214-379-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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