Full Name | |
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Speciality | Community/behavioral Health |
Location | 80 Wright Ave, Roberta, Georgia |
Authorized Official Name and Position | Sandra Olsen (CFO) |
Authorized Official Contact | 4789881002 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
940 Ga Highway 96 Warner Robins GA 31088-2584 Ph: (478) 988-1002 | 80 Wright Ave Roberta GA 31078 Ph: (478) 988-1002 |
NPI Number | 1114195914 |
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Provider Enumeration Date | 02/14/2008 |
Last Update Date | 02/14/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114195914 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (Georgia) | Primary |