| Successful Outcomes-comp | |
|
525 Tomahawk Trl Woodstock GA 30188-1741 | |
| (706) 638-5580 | |
| (706) 638-5445 |
| Full Name | Successful Outcomes-comp |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 525 Tomahawk Trl, Woodstock, 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 |
|---|---|
| Successful Outcomes-comp Po Box 1027 La Fayette GA 30728-1027 Ph: (706) 638-5580 | Successful Outcomes-comp 525 Tomahawk Trl Woodstock GA 30188-1741 Ph: (706) 638-5580 |
| NPI Number | 1043549330 |
|---|---|
| Provider Enumeration Date | 12/15/2009 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043549330 | NPI | - | NPPES |
| 000604513DJ | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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