| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2821 Hwy. 19, Meansville, Georgia |
| Authorized Official Name and Position | Kenny Thompson (VICE PRESIDENT) |
| Authorized Official Contact | 7704633800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 329 Palmetto GA 30268-0329 Ph: (770) 463-3800 | 2821 Hwy. 19 Meansville GA 30256 Ph: (770) 567-8987 |
| NPI Number | 1376742916 |
|---|---|
| Provider Enumeration Date | 07/13/2007 |
| Last Update Date | 07/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376742916 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |