# SOUTH GEORGIA CSB

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Tift C&A Outpatient Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942374343
- **Authorized official:** MR. CHARLES R POWELL (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (229) 671-6101

## Contact information

- **Practice address:** 340 TIFTON ELDORADO ROAD, TIFTON, GA 31794
- **Practice address phone:** (229) 391-2350
- **Practice address fax:** (229) 386-7099
- **Mailing address:** 340 TIFTON ELDORADO ROAD, TIFTON, GA 31794
- **Mailing address phone:** (229) 391-2350
- **Mailing address fax:** (229) 386-7099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 03/17/2010