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General NPI Number Information
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NPI Number | 1952093114
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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 | 05/24/2023
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Last Update Date | 02/19/2025
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Provider Practice Location 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 | 478-663-2222
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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 | 478-663-2222
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | ANDREA SIMMONS
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Credential |
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Telephone | 706-499-1475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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