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General NPI Number Information
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NPI Number | 1558544684
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Entity Type | Organization
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Legal Business Name | BEULAH GROVE COMMUNITY RESOURCE CENTER
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 1448 LEE BEARD WAY
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City | AUGUSTA
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State | GA
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Zip | 30901-3414
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Country | US
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Telephone | 706-828-7468
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Fax | 706-724-7566
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Provider Business Mailing Address
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Address Line | 1448 LEE BEARD WAY
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City | AUGUSTA
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State | GA
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Zip | 30901-3414
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Country | US
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Telephone | 706-828-7468
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Fax | 706-724-7566
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Authorized Official
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Title or Position | MANAGER
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Name | JEAN CALLAWAY
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Credential |
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Telephone | 706-722-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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