Organization
WILLIE COLQUITT HOST HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE SIMPSON (BILLING MANAGER)
(912) 449-7109
Entity
Organization
Contact information
Practice address
1007 MARY ST, WAYCROSS, GA 31503-3823
(912) 449-7109
(912) 449-7056
Mailing address
950 GUS PAULK RD, AMBROSE, GA 31512-3406
(912) 501-7354
(912) 449-7056
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
GA
Other
Enumeration date
11/16/2016
Last updated
11/16/2016
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