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210 E 15th St Woodbine GA 31569-5501 | |
| (912) 576-5075 | |
| (912) 576-3543 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 210 E 15th St, Woodbine, Georgia |
| Authorized Official Name and Position | William Parks (CFO) |
| Authorized Official Contact | 9125548464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
700 Coastal Village Dr Brunswick GA 31520-1974 Ph: (912) 554-8510 | 210 E 15th St Woodbine GA 31569-5501 Ph: (912) 576-5075 |
| NPI Number | 1992834550 |
|---|---|
| Provider Enumeration Date | 03/02/2007 |
| Last Update Date | 10/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992834550 | NPI | - | NPPES |
| 000622553C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
On The Path, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 Georgia Ave, Woodbine, GA 31569 Phone: 912-322-0286 | |
Gateway Behavioral Health Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 210 E 15th St Ste A, Woodbine, GA 31569 Phone: 912-554-8500 |