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General NPI Number Information
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NPI Number | 1669572335
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Entity Type | Organization
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Legal Business Name | NEPTUNE CLINICAL GROUP, INC.
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Dates
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Enumeration Date | 09/23/2006
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 822 CHICKAMAUGA AVE
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City | ROSSVILLE
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State | GA
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Zip | 30741-1407
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Country | US
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Telephone | 706-861-6458
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Fax | 706-866-6277
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Provider Business Mailing Address
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Address Line | 822 CHICKAMAUGA AVE
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City | ROSSVILLE
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State | GA
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Zip | 30741-1407
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Country | US
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Telephone | 706-861-6458
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Fax | 706-866-6277
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DOUGLAS STEPHEN DAVIS
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Credential | CCS, CADC2, CAS
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Telephone | 706-861-6458
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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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