Organization
MCDOUGLE PERSONAL CARE HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA E MCDOUGLE (CEO)
(229) 269-8880
Entity
Organization
Contact information
Practice address
808 BETHUNE ST, VALDOSTA, GA 31601-6202
(229) 300-1389
Mailing address
808 BETHUNE ST, VALDOSTA, GA 31601-6202
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372083530A
—
GA
Enumeration date
04/20/2016
Last updated
04/20/2016
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