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General NPI Number Information
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NPI Number | 1477129377
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Entity Type | Organization
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Legal Business Name | SOUTHERN CRESCENT SEXUAL ASSAULT CENTER, INC.
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 2 W MAIN ST
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City | HAMPTON
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State | GA
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Zip | 30228-2187
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Country | US
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Telephone | 770-507-7772
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Fax |
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Provider Business Mailing Address
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Address Line | 2 W MAIN ST
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City | HAMPTON
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State | GA
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Zip | 30228-2187
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Country | US
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Telephone | 770-507-7772
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. GAYLA L NOBLES
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Credential |
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Telephone | 770-507-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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