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General NPI Number Information
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NPI Number | 1942374343
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Entity Type | Organization
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Legal Business Name | SOUTH GEORGIA CSB
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 340 TIFTON ELDORADO ROAD
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-391-2350
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Fax | 229-386-7099
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Provider Business Mailing Address
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Address Line | 340 TIFTON ELDORADO ROAD
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-391-2350
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Fax | 229-386-7099
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. CHARLES R POWELL
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Credential |
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Telephone | 229-671-6101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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