| |
275 First Street Extention Springfield GA 31329 | |
(912) 754-3040 | |
(912) 754-7108 |
Full Name | |
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Speciality | Psychologist - Rehabilitation |
Location | 275 First Street Extention, Springfield, Georgia |
Authorized Official Name and Position | Rachel Skinner (DIRECTOR OF REIMBURSEMENT) |
Authorized Official Contact | 9125548498 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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700 Coastal Village Drive Brunswick GA 31520-1974 Ph: (912) 554-8510 | 275 First Street Extention Springfield GA 31329 Ph: (912) 754-3040 |
NPI Number | 1073646766 |
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Provider Enumeration Date | 03/13/2007 |
Last Update Date | 11/14/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073646766 | NPI | - | NPPES |
000622553G | Medicaid | GA | |
000622553R | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TR0400X | Psychologist - Rehabilitation | (* (Not Available)) | Primary |