| |
1223 Augusta West Pkwy Ste I Augusta GA 30909-1807 | |
(208) 268-8454 | |
(877) 349-8855 |
Full Name | |
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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 |
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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 |
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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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