Organization
COMMUNITY SERVICE BOARD OF EAST CENTRAL GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE PRIOR (BILLING SUPERVISOR)
(706) 432-4837
Entity
Organization
Contact information
Practice address
1715 LAWERENCE RD, HEPHZIBAH, GA 30815-4445
(706) 432-4837
Mailing address
3421 MIKE PADGETT HWY, AUGUSTA, GA 30906-3815
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000605833AR
—
GA
Enumeration date
02/27/2019
Last updated
02/27/2019
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