1841468097 NPI number — GEORGIA PINES COMMUNITY SERVICE BOARD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841468097 NPI number — GEORGIA PINES COMMUNITY SERVICE BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA PINES COMMUNITY SERVICE BOARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841468097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1102 SMITH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOMASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31792-5739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-225-4335
Provider Business Mailing Address Fax Number:
229-225-4374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1641 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAIRO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39828-1160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-225-4335
Provider Business Practice Location Address Fax Number:
229-225-4374
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
229-225-4373

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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