Organization
MCINTOSH TRAIL CSB
Active
Other names
McIntosh Tr MH MR SA CSB ADT
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA MCCOLLUM (EXECUTIVE DIRECTOR)
(770) 358-8251
Entity
Organization
Contact information
Practice address
101 OWENS LN, PO BOX E, BARNESVILLE, GA 30204-1438
(770) 358-5252
Mailing address
1501A KALAMAZOO DR, GRIFFIN, GA 30224-3919
(770) 358-8250
(770) 229-3223
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000601609V
—
GA
Enumeration date
02/13/2008
Last updated
12/08/2009
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