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250 Scenic Hwy Lawrenceville GA 30045-5675 | |
| (678) 442-5622 | |
| (770) 339-3459 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 250 Scenic Hwy, Lawrenceville, Georgia |
| Authorized Official Name and Position | Thomas Y Mcbride (SR. VP., CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6784424308 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1190 Lawrenceville GA 30046-1190 Ph: (678) 442-5622 | 250 Scenic Hwy Lawrenceville GA 30045-5675 Ph: (678) 442-5622 |
| NPI Number | 1982634572 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 07/26/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982634572 | NPI | - | NPPES |
| 000294A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 067-460 (Georgia) | Primary |
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