| Old Brent Road | |
|
168 Old Brent Rd Forsyth GA 31029-6911 | |
| (478) 803-7602 | |
| Not Available |
| Full Name | Old Brent Road |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 168 Old Brent Rd, Forsyth, Georgia |
| Authorized Official Name and Position | Emily Beth Tyler (CFO) |
| Authorized Official Contact | 4787523231 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Brent Road 168 Old Brent Rd Forsyth GA 31029-6911 Ph: (478) 803-7602 | Old Brent Road 168 Old Brent Rd Forsyth GA 31029-6911 Ph: (478) 803-7602 |
| NPI Number | 1477612810 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 01/30/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477612810 | NPI | - | NPPES |
| 000604194U | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Georgia) | Primary |
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