South Georgia Csb

NPI #1942374343 in Tifton, Georgia

Provider Information

NPI Number: 1942374343
Entity Type: Organization
Organization Name: South Georgia Csb
Primary Specialty: Clinic/Center - Adolescent and Children Mental Health
Enumeration Date: Nov 17, 2006
Last Updated: Mar 17, 2010

Practice Location

Address: 340 TIFTON ELDORADO ROAD
City: Tifton
State: Georgia
ZIP Code: 31794
Phone: (229) 391-2350

Authorized Official

Name: MR. CHARLES R POWELL
Title: CHIEF EXECUTIVE OFFICER
Phone: (229) 671-6101

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health	261QM0855X	Primary

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