Organization
COMMUNITY SERVICE BOARD OF MIDDLE GEORGIA
Active
Other names
McRae Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT KEITH MORAN (CFO)
(478) 272-1190
Entity
Organization
Contact information
Practice address
410 LAKESIDE DRIVE, MCRAE, GA 31055
(478) 272-1190
(478) 274-7628
Mailing address
2121A BELLEVUE RD, DUBLIN, GA 31021-2998
(478) 272-1190
(478) 274-7628
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000606284L
—
GA
05
—
300030912A
—
GA
Enumeration date
03/14/2007
Last updated
07/16/2015
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