Organization
LOOKOUT MOUNTAIN COMMUNITY SERVICE
Active
Other names
Jennifer Dotson
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOM FORD PHD. (CEO)
(706) 638-5580
Entity
Organization
Contact information
Practice address
74 MAPLE DR, SUMMERVILLE, GA 30747-1744
(706) 638-5580
(706) 638-5445
Mailing address
PO BOX 1027, LA FAYETTE, GA 30728-1027
(706) 638-5580
(706) 638-5445
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000604513DQ
—
GA
Enumeration date
03/10/2011
Last updated
03/10/2011
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