Organization
PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JADE RUSSELL BENEFIELD MBA (EXECUTIVE DIRECTOR)
(706) 845-4045
Entity
Organization
Contact information
Practice address
122 GORDON COMMERCIAL DRIVE, SUITE C, LAGRANGE, GA 30240-5740
(706) 845-4045
(706) 845-4367
Mailing address
122 GORDON COMMERCIAL DRIVE, SUITE C, LAGRANGE, GA 30240-5740
(706) 845-4045
(706) 845-4367
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000599332AA
—
GA
05
—
000599332AB
—
GA
05
—
000599332AC
—
GA
05
—
000599332AD
—
GA
05
—
000599332AF
—
GA
05
—
000599332AJ
—
GA
05
—
000599332B
—
GA
05
—
000599332BE
—
GA
05
—
000599332BF
—
GA
05
—
000599332E
—
GA
05
—
000599332G
—
GA
05
—
000599332L
—
GA
05
—
000599332N
—
GA
05
—
000599332T
—
GA
05
—
000599332Y
—
GA
Enumeration date
03/14/2007
Last updated
05/04/2015
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