Organization
THOMAS GRADY SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIANNE ELLIS (DIRECTOR)
(229) 225-4065
Entity
Organization
Contact information
Practice address
106 PLANTATION OAK DR, THOMASVILLE, GA 31792-3500
(229) 225-4065
(229) 225-5027
Mailing address
106 PLANTATION OAK DR, PO BOX 2507, THOMASVILLE, GA 31792-3500
(229) 225-4065
(229) 225-5027
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00669413A
—
GA
Enumeration date
05/08/2007
Last updated
08/22/2020
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