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Organization
SAINT LAZARUS BEHAVIORAL HEALTH INC.
Active
Organization
SAINT LAZARUS BEHAVIORAL HEALTH INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL INIMBOM SAMUEL MD (PRESIDENT)
(865) 765-8224
Entity
Organization
Contact information
Practice address
4905 FORSYTH RD, MACON, GA 31210-4401
(865) 765-8224
(478) 474-6585
Mailing address
273 PROVIDENCE BLVD, MACON, GA 31210-7565
(865) 765-8224
(478) 474-6585
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
056360
GA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
056360
GA
Other
Enumeration date
07/15/2009
Last updated
07/15/2009
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