MEDICARE: METRO TREATMENT OF GEORGIA, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2800X	Methadone Clinic	GA10142M	GA
2	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1083030928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO TREATMENT OF GEORGIA, LP

Provider Business Mailing Address
First Line	:	2500 MAITLAND CENTER PARKWAY
Second Line	:	SUITE 250
City	:	MAITLAND
State	:	FL
Zip	:	32751-4174
Country	:	US
Telephone Number	:	407-351-7080
Fax Number	:	407-351-6930

Provider Business Practice Location Address
First Line	:	1135 13TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2248
Country	:	US
Telephone Number	:	706-887-5030
Fax Number	:	706-243-1877

Authorized Official
Title or Position	:	CFO
Name	:	PATRICK JOHN CHUNN
Credential	:
Telephone Number	:	571-332-3200

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	11/22/2021

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