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NPI Code Detail

MEDICARE: CSB OF EAST CENTRAL GEORGIA

MEDICARE: CSB OF EAST CENTRAL GEORGIA
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609942119
Entity Type Code : Organization
Provider Name (Legal Business Name) : CSB OF EAST CENTRAL GEORGIA
Provider Business Mailing Address
First Line : 124 GORDON ST
Second Line :
City : WASHINGTON
State : GA
Zip : 30673-1602
Country : US
Telephone Number : 706-792-7267
Fax Number : 706-432-3780
Provider Business Practice Location Address
First Line : 124 GORDON ST
Second Line :
City : WASHINGTON
State : GA
Zip : 30673-1602
Country : US
Telephone Number : 706-678-1395
Fax Number : 706-432-3780
Authorized Official
Title or Position : BILLING MANAGER
Name : WANDA L. JESSIE
Credential :
Telephone Number : 706-432-4858
Provider Enumeration Date : 11/27/2006
Last Update Date : 06/19/2008

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Directions to “CSB OF EAST CENTRAL GEORGIA ” Practice Location

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