Organization
PROVISION DUI TREATMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BERRY (CEO)
(229) 449-2575
Entity
Organization
Contact information
Practice address
230 S JACKSON ST, ALBANY, GA 31701-2885
(229) 449-2575
Mailing address
230 S JACKSON ST, ALBANY, GA 31701-2885
(229) 449-2575
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
101YA0400X
GA
Other
Enumeration date
11/20/2015
Last updated
11/20/2015
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