Organization
PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH
Active
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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