Organization
CHOICES FOR LIFE OF GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS CHARLES FELLRATH JD (CEO)
(405) 751-0800
Entity
Organization
Contact information
Practice address
4330 GILBERT AVE, COLUMBUS, GA 31904-6519
(770) 338-0800
(770) 338-2219
Mailing address
4330 GILBERT AVE, COLUMBUS, GA 31904-6519
(770) 338-0800
(770) 338-2219
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CPFC001072
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001462443A
—
GA
Enumeration date
01/07/2009
Last updated
01/07/2009
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