| Childs St. | |
|
151 Childs St Gray GA 31032-5637 | |
| (478) 751-4507 | |
| Not Available |
| Full Name | Childs St. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 151 Childs St, Gray, Georgia |
| Authorized Official Name and Position | Emily Beth Tyler (CFO) |
| Authorized Official Contact | 4787523231 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Childs St. 151 Childs St Gray GA 31032-5637 Ph: (478) 751-4507 | Childs St. 151 Childs St Gray GA 31032-5637 Ph: (478) 751-4507 |
| NPI Number | 1487716577 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487716577 | NPI | - | NPPES |
| 00604194J | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Georgia) | Primary |
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