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General NPI Number Information
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NPI Number | 1457141939
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Entity Type | Organization
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Legal Business Name | THOMASVILLE TREATMENT AND RECOVERY LLC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 701 S HANSELL ST
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City | THOMASVILLE
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State | GA
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Zip | 31792-5558
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Country | US
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Telephone | 229-233-6326
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Fax | 229-516-4887
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Provider Business Mailing Address
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Address Line | 701 S HANSELL ST
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City | THOMASVILLE
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State | GA
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Zip | 31792-5558
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Country | US
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Telephone | 229-233-6326
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Fax | 229-516-4887
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. MARTHA SUSAN WARD
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Credential | MD
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Telephone | 229-233-6326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 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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