Organization
TRI STAR DRUG AND ALCOHOL
Active
Organization
TRI STAR DRUG AND ALCOHOL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN WILLIAM GOOLSBY III (ADMIN)
(478) 246-1027
Entity
Organization
Contact information
Practice address
600 N JEFFERSON ST UNIT C, DUBLIN, GA 31021-6302
(478) 292-5755
Mailing address
600 N JEFFERSON ST UNIT C, DUBLIN, GA 31021-6302
(478) 292-5755
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
332U00000X
Home Delivered Meals
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1421
—
GA
Enumeration date
11/07/2022
Last updated
11/07/2022
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