| Marcus Logan | |
|
168 Oak Hill Dr La Fayette GA 30728-6284 | |
| (706) 638-5580 | |
| (706) 638-5445 |
| Full Name | Marcus Logan |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 168 Oak Hill Dr, La Fayette, Georgia |
| Authorized Official Name and Position | Alicia Michelle Howard (CREDENTIALING) |
| Authorized Official Contact | 7066701080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marcus Logan Po Box 1027 La Fayette GA 30728-1027 Ph: (706) 638-5580 | Marcus Logan 168 Oak Hill Dr La Fayette GA 30728-6284 Ph: (706) 638-5580 |
| NPI Number | 1124343132 |
|---|---|
| Provider Enumeration Date | 04/01/2010 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124343132 | NPI | - | NPPES |
| 000604513DC | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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Linda Dale Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1929 Villanow Mill Creek Rd, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5445 | |
Kaye Horne-host Home Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 Mize St, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5445 | |
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