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General NPI Number Information
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NPI Number | 1871041848
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Entity Type | Organization
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Legal Business Name | SEXUAL ASSAULT CENTER OF NORTHWEST GEORGIA, INC
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 414 SHORTER AVE NW
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City | ROME
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State | GA
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Zip | 30165-4274
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Country | US
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Telephone | 706-292-9024
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Fax | 706-292-0114
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Provider Business Mailing Address
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Address Line | 414 SHORTER AVE NW
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City | ROME
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State | GA
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Zip | 30165-4274
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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 | EXECUTIVE DIRECTOR
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Name | KIM DAVIS
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Credential |
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Telephone | 70629299024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | APC005441
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License Number State | GA
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