Organization
SOUTH GEORGIA CSB
Active
Organization
SOUTH GEORGIA CSB
Active
Other names
Cook DD Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUE GUPTON (CHIEF EXECUTIVE OFFICER)
(229) 671-6101
Entity
Organization
Contact information
Practice address
203 INDUSTRIAL PARK DRIVE, ADEL, GA 31620
(229) 896-7994
(229) 896-3709
Mailing address
203 INDUSTRIAL PARK DRIVE, ADEL, GA 31620
(229) 896-7994
(229) 896-3709
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000607032A
—
GA
05
—
000607032W
—
GA
Enumeration date
11/17/2006
Last updated
12/15/2008
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