Organization
MITCHELL BAKER SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI B. JOHNSON (BILLING CLERK II)
(229) 336-7977
Entity
Organization
Contact information
Practice address
65 INDUSTRIAL BLVD, CAMILLA, GA 31730-3912
(229) 336-7977
(229) 336-1346
Mailing address
65 INDUSTRIAL BLVD, CAMILLA, GA 31730-3912
(229) 336-7977
(229) 336-1346
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000649151A
—
GA
Enumeration date
03/21/2007
Last updated
08/20/2008
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