Organization
LOOKOUT MOUNTAIN COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS W. FORD PH.D. (EXECUTIVE DIRECTOR)
(706) 638-5584
Entity
Organization
Contact information
Practice address
89 HIGHWAY 48, SUMMERVILLE, GA 30747-1506
(706) 857-5465
(706) 857-0934
Mailing address
PO BOX 1027, LA FAYETTE, GA 30728-1027
(706) 638-5584
(706) 638-5585
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00604513U-34
—
GA
Enumeration date
11/20/2006
Last updated
08/22/2020
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