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NPI Code Detail

MEDICARE: COMMUNITY SERVICE BOARD OF MIDDLE GEORGIA

MEDICARE: COMMUNITY SERVICE BOARD OF MIDDLE 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)007-R-0003GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689657637
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY SERVICE BOARD OF MIDDLE GEORGIA
Provider Business Mailing Address
First Line : 2121A BELLEVUE RD
Second Line :
City : DUBLIN
State : GA
Zip : 31021-2998
Country : US
Telephone Number : 478-272-1190
Fax Number : 478-274-7628
Provider Business Practice Location Address
First Line : 2121A BELLEVUE RD
Second Line :
City : DUBLIN
State : GA
Zip : 31021-2998
Country : US
Telephone Number : 478-272-1190
Fax Number : 478-274-7628
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. KEITH MORAN
Credential :
Telephone Number : 478-272-1190
Provider Enumeration Date : 11/23/2005
Last Update Date : 01/12/2016

Similar Medicare Providers

1043203839 — SANDRA L SOUZA M.D.
Practice Location Address:
2121A BELLEVUE RD
DUBLIN, GA
31021-2998
Practice Phone: 478-272-1190
Practice Fax: 478-274-7628
1548245970 — MRS. TAMMIE M LORD RN
Practice Location Address:
2121A BELLEVUE RD
DUBLIN, GA
31021-2998
Practice Phone: 478-272-1190
Practice Fax: 478-272-6509
1477538817 — MRS. CLARE UNDERWOOD BRYAN MED NCC LPC
Practice Location Address:
2121A BELLEVUE RD
DUBLIN, GA
31021-2998
Practice Phone: 478-272-1190
Practice Fax: 478-275-6509
1912982356 — MS. DAWN ANGELIQUE LATTIMORE RN
Practice Location Address:
2121A BELLEVUE RD
DUBLIN, GA
31021-2998
Practice Phone: 478-272-1190
Practice Fax: 478-275-6509
1649255084 — MR. JEROME PAUL MEYERS LCSW
Practice Location Address:
2121A BELLEVUE RD
DUBLIN, GA
31021-2998
Practice Phone: 478-272-1190
Practice Fax: 478-275-6509
1275518615 — A. JAMES GIANNINI MD
Practice Location Address:
2121A BELLEVUE RD
DUBLIN, GA
31021-2998
Practice Phone: 478-272-1190
Practice Fax: 478-274-7628

Directions to “COMMUNITY SERVICE BOARD OF MIDDLE GEORGIA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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