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635 Myron Hart Rd Coolidge GA 31738-2143 | |
(229) 224-0655 | |
(229) 941-5865 |
Full Name | |
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Speciality | Social Worker - Clinical |
Location | 635 Myron Hart Rd, Coolidge, Georgia |
Authorized Official Name and Position | Damon Graham (CEO) |
Authorized Official Contact | 2292240655 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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635 Myron Hart Rd Coolidge GA 31738-2143 Ph: (229) 224-0655 | 635 Myron Hart Rd Coolidge GA 31738-2143 Ph: (229) 224-0655 |
NPI Number | 1780162008 |
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Provider Enumeration Date | 07/30/2018 |
Last Update Date | 03/09/2019 |
Identifier | Type | State | Issuer |
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1780162008 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | CSW005767 (Georgia) | Primary |