Organization
EPIPHANY CENTER ROME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIKA S LEWIS (OWNER)
(770) 500-5062
Entity
Organization
Contact information
Practice address
308 GLEN MILNER BLVD, SUITE 16, ROME, GA 30161-3268
(706) 234-4900
(706) 234-9945
Mailing address
308 GLEN MILNER BLVD, SUITE 16, ROME, GA 30161-3268
(706) 234-4900
(706) 234-9945
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
10109M
GA
Other
Enumeration date
05/26/2011
Last updated
05/26/2011
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