Organization
SOUTH GEORGIA CSB
Active
Other names
MIDTOWN MH-RESIDENTIAL
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA HARRELL (CHIEF FINANCIAL OFFICER)
(229) 671-6100
Entity
Organization
Contact information
Practice address
1209 N TOOMBS ST, VALDOSTA, GA 31601-3931
(229) 671-4255
Mailing address
1209 N TOOMBS ST, VALDOSTA, GA 31601-3931
(229) 671-4255
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GRP2255
—
GA
Enumeration date
07/26/2010
Last updated
07/26/2010
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