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2610 Commons Blvd Augusta GA 30909-2080 | |
| (706) 733-1935 | |
| (706) 667-8727 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2610 Commons Blvd, Augusta, Georgia |
| Authorized Official Name and Position | Kenneth Evan Wilson (DIRECTOR) |
| Authorized Official Contact | 7067331935 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2610 Commons Blvd Augusta GA 30909-2080 Ph: (706) 733-1935 | 2610 Commons Blvd Augusta GA 30909-2080 Ph: (706) 733-1935 |
| NPI Number | 1427139179 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427139179 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 121-502-D (Georgia) | Primary |
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