NPI age
14 years
Enumerated 2011-10-12
Across 2449 active community/behavioral health providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 000604469AI | |
| 01 (GA) | 202G709158 | MEDICARE PTAN |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
Subpart of Oconee Community Service Board.
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