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General NPI Number Information
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NPI Number | 1932596467
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Entity Type | Organization
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Legal Business Name | GEORGIA COMMUNITY CLINIC, LLC
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 8 FRANKLIN RD SUITE A
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City | NEWNAN
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State | GA
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Zip | 30263-1312
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Country | US
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Telephone | 470-414-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 8 FRANKLIN RD SUITE A
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City | NEWNAN
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State | GA
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Zip | 30263-1312
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Country | US
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Telephone | 470-414-2500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HANNAH ADAMS
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Credential | LMSW
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Telephone | 770-282-4492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC008139
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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