| Ellen St Cla | |
|
341 Ellen St Summerville GA 30747-2025 | |
| (706) 638-5580 | |
| (706) 638-5445 |
| Full Name | Ellen St Cla |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 341 Ellen St, Summerville, Georgia |
| Authorized Official Name and Position | Tom Ford (CEO) |
| Authorized Official Contact | 7066385580 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellen St Cla Po Box 1027 La Fayette GA 30728-1027 Ph: (706) 638-5580 | Ellen St Cla 341 Ellen St Summerville GA 30747-2025 Ph: (706) 638-5580 |
| NPI Number | 1790075679 |
|---|---|
| Provider Enumeration Date | 04/13/2011 |
| Last Update Date | 04/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790075679 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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