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628 Southside Commercial Pkwy Jonesboro GA 30236-8912 | |
| (678) 249-5323 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 628 Southside Commercial Pkwy, Jonesboro, Georgia |
| Authorized Official Name and Position | Willie M Simpson (EECUTIVE DIRECTOR) |
| Authorized Official Contact | 6782495323 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
821 Lorraine Ln Stockbridge GA 30281-7624 Ph: (678) 249-5323 | 628 Southside Commercial Pkwy Jonesboro GA 30236-8912 Ph: (678) 249-5323 |
| NPI Number | 1235314733 |
|---|---|
| Provider Enumeration Date | 01/02/2008 |
| Last Update Date | 01/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235314733 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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