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Organization
SOUTH GEORGIA CSB
Active
Organization
SOUTH GEORGIA CSB
Active
Other names
Tift C&A Outpatient Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES R POWELL (CHIEF EXECUTIVE OFFICER)
(229) 671-6101
Entity
Organization
Contact information
Practice address
340 TIFTON ELDORADO ROAD, TIFTON, GA 31794
(229) 391-2350
(229) 386-7099
Mailing address
340 TIFTON ELDORADO ROAD, TIFTON, GA 31794
(229) 391-2350
(229) 386-7099
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
11/17/2006
Last updated
03/17/2010
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