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1223 Augusta West Pkwy Ste I Augusta GA 30909-1807 | |
| (208) 268-8454 | |
| (877) 349-8855 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1223 Augusta West Pkwy Ste I, Augusta, Georgia |
| Authorized Official Name and Position | Jeremy M Thorndyke (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 2082688454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2601 Traverse Trl Evans GA 30809-0990 Ph: (208) 268-8454 | 1223 Augusta West Pkwy Ste I Augusta GA 30909-1807 Ph: (208) 268-8454 |
| NPI Number | 1952124893 |
|---|---|
| Provider Enumeration Date | 11/07/2024 |
| Last Update Date | 11/18/2024 |
| Certification Date | 11/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952124893 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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