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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