Organization
COMMUNITY SERVICE BOARD OF MIDDLE GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH MORAN (CFO)
(478) 275-6811
Entity
Organization
Contact information
Practice address
207 N ANDERSON DR, SWAINSBORO, GA 30401-4440
(478) 289-2619
(478) 289-2622
Mailing address
223 N ANDERSON DR, SWAINSBORO, GA 30401-4440
(478) 289-2683
(478) 289-2798
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000606383G
—
GA
Enumeration date
06/28/2017
Last updated
06/28/2017
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