Organization
PINELAND MH/MR/SA CSB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUNE A DIPOLITO (EXECUTIVE DIRECTOR)
(912) 764-6906
Entity
Organization
Contact information
Practice address
901 NORTH ST W, VIDALIA, GA 30474-3503
(912) 537-9316
(912) 537-9915
Mailing address
5 W ALTMAN ST, STATESBORO, GA 30458-5212
(912) 764-6906
(912) 764-3252
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
LPN068072
GA
Other
Enumeration date
05/01/2008
Last updated
05/01/2008
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