Organization
GERDIE AND LOUISE PCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUSITNE TAYLOR LEWIS (OWNER)
(912) 515-5030
Entity
Organization
Contact information
Practice address
104 ROBBINS ST, SYLVANIA, GA 30467-2532
(912) 515-5030
Mailing address
106 HARDEN RD, STATESBORO, GA 30458-2717
(912) 515-5030
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
121010101
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
996863388A
—
GA
Enumeration date
04/08/2011
Last updated
04/08/2011
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