Organization
OLD TOWN OUTPATIENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN FAULKENBERRY (OPERATOR)
(912) 223-4363
Entity
Organization
Contact information
Practice address
508 SUNSET BLVD, BRUNSWICK, GA 31525-2082
(912) 223-4363
Mailing address
508 SUNSET BLVD, BRUNSWICK, GA 31525-2082
(912) 223-4363
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
02/07/2022
Last updated
02/07/2022
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