Organization
DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Active
Other names
Central State Hospital Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY LATHAM (REGIONAL HOSPITAL ADMINISTRATOR)
(478) 445-4128
Entity
Organization
Contact information
Practice address
325 LAWRENCE RD, CENTRAL STATE HOSPITAL, MILLEDGEVILLE, GA 31062-7525
(478) 445-4041
Mailing address
325 LAWRENCE RD, CENTRAL STATE HOSPITAL, MILLEDGEVILLE, GA 31062-7525
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
PHH006409
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00355704A
—
GA
Enumeration date
08/16/2006
Last updated
09/15/2011
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