| Ellijay Center For Change, Pc | |
|
89 Hospital Cir Suite 8 Ellijay GA 30540-9669 | |
| (706) 698-2400 | |
| (706) 698-2401 |
| Full Name | Ellijay Center For Change, Pc |
|---|---|
| Speciality | Counselor |
| Location | 89 Hospital Cir, Ellijay, Georgia |
| Authorized Official Name and Position | Cheryl Keats (OWNER) |
| Authorized Official Contact | 7066982400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellijay Center For Change, Pc 89 Hospital Cir Suite 8 Ellijay GA 30540-9669 Ph: (706) 698-2400 | Ellijay Center For Change, Pc 89 Hospital Cir Suite 8 Ellijay GA 30540-9669 Ph: (706) 698-2400 |
| NPI Number | 1669700837 |
|---|---|
| Provider Enumeration Date | 11/30/2009 |
| Last Update Date | 11/30/2009 |
| Medicare PECOS PAC ID | 7416120175 |
|---|---|
| Medicare Enrollment ID | O20130710000866 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669700837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | CSW001990 (Georgia) | Primary |
| Provider Name | Cheryl M Keats |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841254307 PECOS PAC ID: 0345219531 Enrollment ID: I20130710000912 |
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