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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