| The Wings Of Holly Blue Llc | |
|
815 S Main St Moultrie GA 31768-5434 | |
| (760) 585-5522 | |
| (760) 433-5414 |
| Full Name | The Wings Of Holly Blue Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 815 S Main St, Moultrie, Georgia |
| Authorized Official Name and Position | Debra Howard (CEO) |
| Authorized Official Contact | 7605855522 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Wings Of Holly Blue Llc 815 S Main St Moultrie GA 31768-5434 Ph: (760) 585-5522 | The Wings Of Holly Blue Llc 815 S Main St Moultrie GA 31768-5434 Ph: (760) 585-5522 |
| NPI Number | 1184480170 |
|---|---|
| Provider Enumeration Date | 02/27/2024 |
| Last Update Date | 04/11/2024 |
| Certification Date | 04/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184480170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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