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Organization
GEORGETOWN MEDICAL, LLC
Active
Organization
GEORGETOWN MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBYN TANIS (EXECUTIVE DIRECTOR OF CONTRACT MGMT)
(856) 533-8762
Entity
Organization
Contact information
Practice address
105 EASTSIDE DR, GEORGETOWN, KY 40324-9797
(502) 868-0664
Mailing address
1317 ROUTE 73 STE 200, MOUNT LAUREL, NJ 08054-2202
(856) 439-6111
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
810355
KY
261QR0800X
Recovery Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
810355
STATE LICENSE
KY
Enumeration date
05/21/2014
Last updated
09/10/2026
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