Organization
CSB OF EAST CENTRAL GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA JESSIE (BILLING SUPERVISOR)
(706) 432-4858
Entity
Organization
Contact information
Practice address
3421 MIKE PADGETT HWY, AUGUSTA, GA 30906-3815
(706) 432-4858
(706) 432-3780
Mailing address
3421 MIKE PADGETT HWY, AUGUSTA, GA 30906-3815
(706) 432-4858
(706) 432-3780
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00605833E
—
GA
Enumeration date
04/03/2008
Last updated
06/19/2008
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