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General NPI Number Information
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NPI Number | 1841146362
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Entity Type | Organization
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Legal Business Name | GEORGIA RECOVERY CAMPUS,LLC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 602 3RD ST
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City | AUGUSTA
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State | GA
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Zip | 30901-2570
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Country | US
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Telephone | 478-216-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 211 GOOSE HOLLOW RD
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City | REYNOLDS
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State | GA
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Zip | 31076-3505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | AMBER BLACKLOCK
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Credential |
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Telephone | 478-216-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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