Organization
SEXUAL ASSAULT CENTER OF NORTHWEST GEORGIA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM DAVIS (EXECUTIVE DIRECTOR)
70629299024
Entity
Organization
Contact information
Practice address
414 SHORTER AVE NW, ROME, GA 30165-4274
(706) 292-9024
(706) 292-0114
Mailing address
414 SHORTER AVE NW, ROME, GA 30165-4274
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
APC005441
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23566666
—
GA
Enumeration date
09/19/2016
Last updated
09/19/2016
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